PNEUMONIA: 



ITS SUPPOSED CONNECTION, 



PATHOLOGICAL AND ETIOLOGICAL, 



AUTUMNAL FEYERS; 



INCLUDING 



AN INQUIRY INTO THE EXISTENCE AND MORBID AGENCY 



MALARIA. 



BY 

R. LA ROCHE, M. D., 

MEMBER OF THE AMERICAN PHILOSOPHICAL SOCIETY; OP THE AMERICAN MEDICAL ASSOCIATION j 

FELLOW OF THE COLLEGE OF PHYSICIANS OF PHILADELPHIA; CORRESPONDING MEMBER 

OF THE IMPERIAL ACADEMY OF MEDICINE, AND FOREIGN ASSOCIATE OF THE 

MEDICAL SOCIETY OF EMULATION, OF PARIS ; OF THE ACADEMIES OF 

SCIENCES OF TURIN, COPENHAGEN, STOCKHOLM, AND NANCY; OF 

THE MEDICAL SOCIETIES OF MARSEILLES, LYONS, 

ETC, ETC. 




PHILADELPHIA: 
BLAN CHARD AND LEA. 

1854. 



Entered according to the Act of Congress, in the year 1854, by 

BLANCHAKD AND LEA, 

in the Office of the Clerk of the District Court of the United States in and for the 
Eastern District of Pennsylvania. 



PHILADELPHIA: 

T. K. AND P. G. COLLIN'S, PRINTERS. 






TO CHARLES D. MEIGS, M.D. 

Dear Doctor : — 

To no one more appropriately than to yourself can I dedi- 
cate this volume. The innumerable marks of friendly, and indeed 
affectionate regard, I have received at your hands, and the devoted 
professional care you have taken of me and mine, by day and by 
night, during a period extending over more than a quarter of a 
century, and amid many painful trials through which a kind Provi- 
dence has enabled me to pass, entitle you to this trifling return. 
May I trust you will receive it as a token of the sincere affection 
I entertain for you? Greatly do I wish I could know, or even 
think, that the volume which I here place before you were fully 
worthy of your acceptance. Before one line of it was prepared for 
publication in its present form, I had decided, as by the result of 
an insti active impulse, to enhance its value by placing your honoured 
name at its head; and no one who can appreciate the feeling which 
prompted me, will needs be told that I have striven on that account 
to render the book what it ought to be. The effort may possibly — 
I fear will certainly — be thought by intelligent medical readers to 
have proved abortive. The results of my thoughts and researches, 
of my serious reflections and careful observations, may perhaps fail 
to meet the expectations of even the few indulgent professional 
friends who were apprised of my intention to appear before the 
public in this, to me, new capacity. But, should my volume meet 
the fate which many like it have suffered, and many more deserve 
to suffer, at the hands of the tribunal to whose decision all produc- 
tions of the kind must be submitted — should it be soon consigned 
to oblivion — I shall feel neither disappointment nor regret, provided 
I can be certain that you have received some gratification at my 
having selected you as its sponsor. Would it could prove the 
worthy rival of the great, and unfortunately unfinished work of 



iv LETTER TO CHARLES D. MEIGS. 

our common illustrious friend, the late Dr. Drake, whose loss we 
cannot cease to deplore, and of whose reputation every member of 
our profession in this country must be proud. But this I could no 
more hope than you could expect ; and I must be satisfied if my 
unpretending production can be read by you, and other medical 
men whose opinions are entitled to confidence, with some mani- 
festation of approbation. 

It cannot but be a matter of astonishment to you, who know 
something of my tastes and habits, and of the tardiness and even 
reluctance I have heretofore shown in preparing for publication 
materials long ago collected and arranged on a favourite and im- 
portant subject, that I should so unexpectedly alter my course, and 
place before the public a work treating of a topic on which, two 
years ago, I had no more intention of writing than I have now of 
composing a practical treatise on your specialty. But so it is — 
Lliomme propose, et Dieu dispose. Here I am laying aside the results 
of a labour of years, and troubling that very same public with a 
work of questionable interest on a subject only indirectly connected 
with that of my former researches. A few words in explanation 
of my reasons for so acting may not be out of place. 

The present volume, like some better ones, has grown to its 
actual respectable dimensions from very small beginnings. The 
first step in its production was the writing of a friendly letter of a 
dozen pages, to a most valued friend, who holds an important posi- 
tion among the physicians and teachers of a distant State, in review 
of a clever essay by him, on Pneumonia. In the course of a cor- 
respondence which ensued on the subject, I prepared and for- 
warded another and much longer letter, in which some of the views 
set forth by him were critically examined. Soon after, those com- 
munications were, at the suggestion of several friends, converted into 
Essays, and published in successive issues of the Charleston Medical 
Jonmal. There they attracted the attention of some physicians, 
whose views on the various topics treated of coincide with mine, 
and were noticed with commendation in a few medical periodicals. 
Ki-« .in various quarters, 1 received the advice to publish them in a col- 
lecied and more permanent form. 1 shall not stop to inquire whether 
this advice was impartial, or whether it was not rather founded on 
an unmerited estimate of the importance of the Essays, resulting 
from the disturbing influence which personal attachment is so apt 
to create under circumstances of the kind; for on a question con- 



LETTEK TO CHARLES D. MEIGS. V 

cerning the value of my own production, I leave the decision to 
others. But, however this may be, after some hesitation, I yielded, 
perhaps unwisely, to that advice, and lost no time in preparing the 
whole for the press — cutting out, adding, rearranging, and often 
rewriting. I am not sure that by these changes I have improved 
the original publication. On that score, indeed, I have had mis- 
givings, and at times entertained serious thoughts of consigning the 
whole to the flames. But again I submitted to the decision of those 
in whose judgment I repose confidence. Encouraged by their opin- 
ion, I dare hope that if, by acting as I have done, no improvement 
in the original text has been effected, I shall, at least, not be taxed 
with having augmented the many blemishes it already contained. 

While entertaining this hope, I cannot help fearing that my pro- 
fessional readers, and yourself among them, will disapprove of the 
result of my labours, when it is perceived that, instead of curtailing 
the many redundances, omitting the facts of doubtful importance, 
abridging the lengthy statements, and expunging a large amount of 
the references embodied in the original publication, I have added 
fresh materials to the stock. Not less do I fear that I shall be 
censured for not having taken adequate pains to elaborate the 
whole, to class properly and clearly the various topics examined, to 
avoid enlarging unduly on some points, and slurring over others, 
as well as to correct and polish the language. 

But although ready to admit that in these matters the volume is 
amenable to the censure of tasteful readers, and fairly exposed to 
the lash of the critic, I cannot but think that those who honour me 
with an attentive perusal, will abate somewhat of the severity of 
this judgment, when they reflect that the main object of the work 
was, not to produce an elegant and finished composition, but to 
point out the erroneousness of views entertained by respectable 
writers on certain pathological and etiological subjects; that this 
could not be more successfully done than by accumulating as many 
facts as possible, with a view to sustain each limb of the argu- 
ment; and that, in order to impress on the mind of the inquirer an 
idea of the appositeness and authenticity of those facts, and to 
enable him to verify their accuracy, it would be advantageous to 
give them mostly in the language of their reporters, and to state 
exactly where the records of them were to be found. 

In reference to the want of artistic skill displayed throughout 
the entire volume, I can only express my regret. Wo one is more 



v i LETTER TO CHARLES D. MEIGS. 

aware of the defect than myself. Nor shall! deny that the charge 
respecting the absence of a proper classification, and the dispropor- 
tionate extent allotted to some of the subjects treated of, at the ex- 
pense of others, is well founded. I feel especially that I might, 
without detriment, have disconnected the long inquiry relative to 
the existence and morbific agency of malaria in the production of 
autumnal fevers from the rest of the work, have given it a separate 
and independent form, and published it apart ; or, what would per- 
haps have been still better, omitted it altogether; and, taking for 
granted — what is not far from the truth — that nearly every one 
admits the existence and agency of a febrile poison, have proceeded 
in the argument without troubling myself with the denials of a few 
opponents. Such might, perhaps, have been my course, but I 
thought otherwise at the time ; and, indeed, think so still. In order 
to sustain the position I had assumed, it was necessary to show 
that pneumonia, which some writers regard as a mere form of 
autumnal fevers, arises from causes distinct from those to which the 
latter diseases are due ; and it appeared to me that this could not 
be better done than by first inquiring what those causes really 
were, and then showing that, while pulmonary inflammation is pro- 
duced by a certain set of agencies, the fevers in question are the 
offspring of a specific gaseous poison. But, at the same time, it 
occurred to me that, as some of the advocates of the identity of 
those diseases disbelieved the existence and ignored the agency of 
this poison, my task would be unfinished were I not to demon- 
strate their errors on this point. Influenced by these views, I set 
to work ; facts, and what I may, perhaps wrongfully, consider argu- 
ments, accumulated under my pen, and the result has been the 
strange compound I to-day lay before you, and for the many im- 
perfections of which I solicit your kind indulgence. 

I need not tell you — for you will easily perceive on casting 
your eyes over the following pages — that I have not aimed 
at offering anything new; that it has not been my object to 
.-'art a new theory or hypothesis, and to establish it on grounds, 
and by facts, heretofore unknown, and by the help of arguments 
equally unheard of. So far from this, I have no hesitation in 
king t hut the idea of claiming credit for originality has never 
entered my mind. All the credit to which I think myself entitled 
—if any can be legitimately considered due to me— is for having 
d, within a comparatively small compass, the main facts 



LETTER TO CHARLES D. MEIGS. Vll 

bearing on the question at issue, derived from reliable sources in 
various sections of the globe, and from the results of my own per- 
sonal observation ; for having examined, to the best of my ability, 
the subject in all its bearings; for having demonstrated, in as for- 
cible a way as I have been able, that the idea of the identity under 
consideration is founded on insufficient and incorrect data, and is, 
in fact, little more than a dream of the imagination; and, at the 
same time, for having proved that etiologists who regard the various 
forms of autumnal fevers as due to the action of particular poisons 
floating in the atmosphere of specific localities, have just cause for 
entertaining that belief. This, I repeat, is all I have attempted to 
perform. 

Nature has, I think, given me a decided taste for certain inves- 
tigations — a large share of power of application — some degree of 
aptness, as I have been told, to observe and reason correctly. At 
the same time, circumstances have often been such as to allow me 
leisure to indulge my inclination for research; while, during the 
third part of a century that I have been attached to the medical 
profession, my opportunities for observation have neither been few 
nor neglected. But to originality of thought, or the ability to make 
striking discoveries, I can lay no claim. Indeed, were I so gifted. 
I am not sure that I should not endeavour to restrain the exercise 
of these powers, for fear of entering into the boundless field of hy- 
pothesis. On this subject my mind has long been made up ; and 
from all I have seen, I can entertain no doubt, that more good is 
to be effected by a patient accumulation and comparison of im- 
portant facts, and by endeavouring to draw from the whole correct 
philosophical deductions, than by adopting a different course, too 
common among the professional writers of this country and else- 
where ; who, discarding the results of the experience of former 
and present times, and relying exclusively on their own too often 
scanty observations, make up for their other deficiencies by an 
indulgence in theoretical explanations ; and sneer at the patient r 
slow, and cautious observer, and the erudite student. That the 
tendenc} 7 " to the course here adverted to is displayed by a goodly 
number of physicians among us is, as you know full well, too true to 
be denied. It has long been to me, and to others on whose natural 
good sense, sound judgment, and medical scholarship we may rely, 
a source of deep solicitude ; threatening, as it does, if allowed to 
continue unchecked, to affect injuriously our literary and scientific 



viii LETTER TO CHARLES D. MEIGS. 

character, and to retard the advancement of useful professional 
knowledge among us. The picture I have drawn is not exaggerated ; 
and the history of medicine clearly shows that those who have im- 
proved the scientific and practical department of our art, have, with 
few exceptions, been men, not of lively imagination and inventive 
powers of mind, but careful and industrious observers; men of 
sound judgment, and of well-read and cultivated minds. 

Indeed, this subject is so important and interesting, that I trust 
it will justify my taking this opportunity to offer a few remarks on 
some of the leading circumstances which have exercised an injurious 
influence on medical literature and professional knowledge in this 
country, and which it ought to be the aim of every true votary of 
our art to modify and remove. 

Compared with that of Europe, whether of Germany, France, 
England, or even Italy, the medical literature of the United 
States may be said to be as yet in a state of infancy. This is true 
both as regards the number of original publications which issue 
from the press, and their practical importance, scientific character, 
or literary merit. It would be unnecessary, and out of place, to 
dwell here on the causes which have contributed to produce this 
result; but, be they what they may, that result is placed beyond 
the possibility of doubt; for no professional reader can have failed 
to perceive that, although original treatises, monographs, and elabo- 
rate essays on various branches of medical science, have appeared 
on this side of the Atlantic, their number is comparatively limited J 
and it is a fact which no one here will venture to deny that, while 
some of these would do honour to any country, the greater number 
are not of such a character as to entitle them to general commenda- 
tion and lasting attention. Not less readily will it be admitted, by 
those who take an expansive survey of the minor medical produc- 
tions of this country, such a§ original essays of small size, either 
issued in a separate form, or as contributions to periodical journals, 
that, although more numerous than the former class, they seldom 
add anything to the character of our professional literature, and ex- 
hibit even less merit, both in reference to the matter they contain, 
and the manner in which they are written, than might have been 
anticipated when we consider the multitude of physicians scat- 
tered over the vast extent of this country, the unlimited opportu- 
nities for collecting observations of interest and value within their 
reach, as well as the sound sense and the capacity for practical and 



LETTER TO CHARLES D. MEIGS. IX 

scientific investigation which form attributes of the American mind. 
With these facts before him, every American physician who is alive 
to the honour, dignity, and interest of his profession, will unite in 
the opinion that we have, so far as medical literature is concerned, 
a character, not to uphold merely, but to establish; and that conse- 
quently it behooves him, while neglecting no means to improve 
himself in the various branches of medical science, to shun care- 
fully, and to reprove in others, every practice which may, in any 
degree, retard the accomplishment of so desirable an end. 

It would be impossible, in the space allowed me on this occasion,, 
to point out in detail the several baneful influences here alluded to ; 
let it suffice to dwell on two of the more prominent. It is not un- 
common to find inexperienced medical writers in this country — as, 
indeed, elsewhere — hazarding, on physiological, pathological, etio- 
logical, or practical subjects, opinions completely at variance with 
those which the enlightened portion of medical men, throughout 
the civilized world, regard as placed beyond the reach of cavil or 
disputation, or, at least, as entitled to the most respectful considera- 
tion. Some, in their dissent from the current opinion of the medi- 
cal world, content themselves with throwing out a simple conjecture, 
or perchance pronouncing a positive statement. Others, more am- 
bitious, bring forward a complex theory, or do not hesitate to enter 
upon systematic developments. Nor is it less common to find these 
scientific aspirants upholding their novelties by an ostentatious dis- 
play of argument, by an appeal to collateral illustrations, and by a 
triumphant reference to facts of a more or less apposite character ; 
the whole seasoned with a confident and uncompromising assertion 
of the legitimacy of their deductions, and with a decided, sometimes 
contemptuous, condemnation of the views entertained on the same 
subjects by all preceding or contemporary writers. As might be 
foreseen, such attempts at innovation, the detailed enumeration of 
which would form an amusing chapter in the history of our profes- 
sion, have so far, with occasional exceptions, failed to produce the 
effects intended, and to command general and continuous atten- 
tion. 

Novel explanations of known phenomena are offered; analogies 
or differences heretofore unthought of, are pointed out and insisted 
upon ; effects are ascribed to causes, which before were unsuspected 
of producing them ; while, on the other hand, the agency of morbid 
influences, universally regarded as occasioning certain phenomena, 



X LETTER TO CHARLES D. MEIGS. 

is denied; remedies are asserted to possess powers very different 
from those usually attributed to them ; superiority of success is 
claimed for modes of treatment which experienced practitioners 
have been taught to view with suspicion ; but all in vain. The 
reader, if not a novice in medical literature, and a tyro in profes- 
sional knowledge, is not slow to discover the small degree of reli- 
ance which can be placed on such attempts at innovation ; and 
finds that the theories or hypotheses so pompously and confidently 
set forth, so far from being satisfactory, and likely to answer the 
purpose of their authors, are generally of a loose, crude, and un- 
philosophical character ; in many cases evidently the offspring of 
men who are young in years and young in experience, who are 
richer in self-esteem and assurance than discretion and learning ; 
of men whose minds are immature, untrained, and ill stored. He 
finds that they are founded on hastily collected and ill-digested 
observations, cemented together by illogical or overstrained reason- 
ings, and though fit, perhaps, for the edification of young beginners, 
are unworthy of serious consideration on the part of men of mature 
age, and sound and extensive acquirements. 

Not unfrequently, the well-informed reader recognizes in the 
proposed novelty some old acquaintance, which — after having 
enjoyed, at some bygone time, an ephemeral reputation, had dis- 
appeared under the lash of the reviewer, or sunk into oblivion 
from an innate want of vital force — is now once more brought forth, 
in a more or less modified garb, to glitter for a short moment in the 
eyes of the unskilled, and, of course, soon to meet a fate similar to 
that it had already encountered. Even when he finds, in such 
lucubrations, something calculated to amuse or interest, or some- 
times, perchance, to seduce him momentarily from the more rational 
opinions he had before entertained, he in a brief while becomes 
sensible of his error, and reverts to his former faith. If he does not 
forget what he has just read, he at least views it in the same light as 
other vagaries, of which the annals of medicine, both on this and on 
the other side of the Atlantic, furnish many a curious example. 
With such facts before him, he cannot be regarded as over fastidious 
if he unite in sentiment with those who maintain that the stuff of 
which medical reformers and leaders in scientific advancement are 
da ifi a rare product; that in all parts of the world, and here, per- 
'!■<• than elsewhere, readiness and smartness have but too 
ii mistaken for strong power of thought, and superficial in- 



LETTER TO CHARLES D. MEIGS. XI 

formation has taken the place of sound and accurate learning ; that 
in a field where men of well-disciplined and well-stored minds, and 
rich in accurate observation — men who have within their reach 
the means of testing the statements of other investigators, whose 
standing is equal to their own — men who live, as it were, in an 
atmosphere of science, have failed ; it is scarcely to be expected 
that individuals of ordinary capacity, with little experience, and as 
little reading, who are unused to accurate processes of scientific 
investigation and close induction, and who possibly move within 
localities where opportunities for prosecuting the requisite researches 
on a sufficiently enlarged scale are, in a great measure, wanting, will 
reap laurels, and assume a conspicuous place in the ranks of medi- 
cal reformers, or add greatly to the stock of useful knowledge. 

The cause of these successive and repeated efforts at revolution- 
izing the science in some or all of its parts, of this reluctance to 
pursue the common track, and of this disposition to discard 
opinions long entertained, and to substitute others of a contrary 
character, need not be made here the subject of detailed examina- 
tion. That in some cases the result is due solely, or in a great 
measure, to a craving after notoriety — to the ambitious desire to be 
pointed out by medical or rather by unprofessional men, as authors 
of brilliant discoveries, and as gifted agents of scientific and practi- 
cal improvements; in other words, that the guiding impulse is 
more frequently the desire for personal advancement and pecuniary 
gain, than a due regard for the interest of science, we have every 
reason to conclude. Equally true is it, that we may sometimes 
trace this result to the mere desire of gratifying the innocent and 
harmless vanity to which some individuals, especially young medi- 
cal men, fresh from the schools, are keenly alive, that of seeing their 
names in print; more particularly if they can so appear in con- 
nection with something really or seemingly new, and calculated to 
attract attention. These lucubrations, though of no earthly value 
to any one in a scientific or other point of view, are to their pro- 
mulgators objects of vast importance; and hence the desire to see 
them spread out in the pages of a medical journal, side by side 
with the contributions of older and better known physicians. We 
may also suppose that, in some instances, it is the offspring of the 
foible which nature has infused into the composition of some happy 
individuals, who imagine themselves endowed with the faculty of 
unravelling the most intricate mysteries of the science, and of 



xii LETTEE TO CHAKLES D. MEIGS. 

discovering truths heretofore concealed from the notice of medical 
investigators from the days of Hippocrates to the present; and 
who fancy they can explain all professional questions, however 
complex and apparently foreign to their ordinary pursuits or their 
opportunities of inquiry, in a more lucid, natural, and satisfactory 
way than any of their predecessors or contemporaries. 

Such is the probable explanation in many instances. But the 
medical world is occasionally startled by the appearance of hypotheses 
and theories, both crude and untenable, and sometimes of more 
than problematical originality, by a very different class of men. 
The hypotheses to which allusion is here made are promulgated 
with unflinching confidence by individuals to whom, from the 
distinguished position they have reached in the ranks of the pro- 
fession, from the respectable character of their intellectual endow- 
ments, from the extent of their general and medical acquirements, 
no less than from the high standing of their moral character, we 
cannot justly attribute selfish considerations, youthful vanity, or 
the monomania of authorship ; and who might have been expected 
to abstain from the attempt to stem the current of received opinions, 
and to aspire to the honours awarded to true medical reformers, and 
correct exponents of new views. In these, the cause must be sought, 
sometimes in the want of a proper balance between the fancy and the 
judgment, a defect which leads the individual to mistake ingenious 
flights of the imagination, odd notions, and whimsicalities, for correct 
inferences from enlarged and accurate observations. In others, it is 
to be found in a disposition, not uncommon even among otherwise 
clever men, to discard received opinions whenever, in their estima- 
tions, these do not prove satisfactory on all points, however shadowy 
may be the grounds of dissatisfaction, and to fly at once to the most 
opposite modes of explanation. 

In a different class, we must seek the explanation in a restless 
tendency, not unfrequently exhibited by individuals whose minds, 
though naturally good and well cultivated, have, nevertheless, 
not been thoroughly trained in the school of severe induction, to 
jump hastily at conclusions and to draw inferences without having 
collected, analyzed, and compared a sufficient number of facts, 
bearing directly or indirectly on the point at issue. Sometimes we 
find it in a disinclination to examine the subject in all its bear- 
ings; in a deficiency in the power of appreciating the full force of 
facts and circumstances militating against the views adopted, or a too 



LETTEE TO CHARLES D. MEIGS. Xlll 

habitual tendency to undervalue the authority of those by whom 
they are adduced. Again, it is traced to an inability to discover the 
connection existing as cause and effect, between the phenomena 
to which attention is called ; and quite as frequently, to a scanty 
acquaintance with what has been already written on the subject on 
which the author proposes to enlighten the medical public. 

It has been remarked by competent judges, that the first thing 
an individual should attend to, who undertakes to write on pro- 
fessional topics, especially when he fancies he has discovered new 
truths, or devised a theory respecting the reciprocal relations of 
facts already known, which is more acceptable than any anteriorly 
received, is to make himself familiar with all that has been written 
on the subject. " When the observer," says Sprengle, " whatever be 
the extent of his genius, has, nevertheless, not enough of erudition 
to be acquainted with the observations of his predecessors, he runs 
the risk of repeating what has already been said a hundred times 
before, and of publishing it as his own discovery. Hence, the 
advantages of true erudition." 1 

Well would it be for aspiring reformers and discoverers, abroad 
and at home, were they to take heed of the sage advice of the 
great historian of medicine. By enlarging the sphere of their pro- 
fessional erudition beyond a few text and other works of easy 
access, or the numbers of some periodical journals, they would pos- 
sibly be deterred from laying before the medical world the products 
of their unimportant cogitations, and the results of their imperfect 
observations, seeing that others, differing but little from them, had 
been presented — perhaps more forcibly and clearly — before, and 
had been long refuted or disproved, or passed by without comment 
or sign of approbation ; thus saving themselves the risk of disap- 
pointment, perhaps mortification, and sparing to others a vast 
amount of useless reading. 

Easy as it may be to account for the manifestation of the pro- 
pensity in question among the several classes of physicians just 
passed in review, yet instances occasionally present themselves, in 
which opinions of an unsatisfactory, untenable — not to say extrava- 
gant character, often of more than doubtful originality, and which, 
if proved to be well founded, would overturn all our previous and 
long- established views, are thrown out, and boldly and confidently 

1 Handbook of Pathology, vol. i. 



xiv LETTER TO CHARLES D. MEIGS. 

asserted, in quarters where none of the explanatory reasons above 
enumerated would seem to apply. 

These opinions originate with individuals in whom the imagina- 
tive powers have always appeared to be .properly tempered by 
sound judgment ; who have not, in other matters, evinced a tend- 
ency to adopt hasty and far-fetched conclusions; whose field of 
observation has been ample, and assiduously and profitably culti- 
vated ; whose search after information on collateral branches of 
knowledge has never been neglected ; and by whom care has evi- 
dently been taken to render themselves familiar with a large share 
of the writings of the best authors. These stand apart from all 
other innovators, and might properly be made here the subject of 
some remarks; but, from want of room, and the fear of exhausting 
the patience of the reader, which has been already too heavily 
taxed, I must resign into other and abler hands the duty of clear- 
ing up the mystery which this manifestation of the tendency of 
which I am speaking is so well calculated to create. 

It is needless to illustrate the correctness of these remarks by a 
detailed account of instances in which the propensity in ques- 
tion has been indulged to a greater or less degree. Cases, in which 
facts and views long familiar to well-read physicians have been 
seriously presented as new, or cases in which the strangest vagaries 
have been launched forth, and strenuously maintained, will doubt- 
less present themselves to the mind of every reader, who will find 
no difficulty in placing the authors of them in some one or other of 
the categories above enumerated. 

It is important that the aspirant to professional fame, who places 
himself before the public in the capacity of author, should carefully 
avoid every attempt, or semblance of an attempt, to pass off as his 
own, in whole or in part, what in reality belongs to others. In 
other words, too much care cannot be taken by medical writers to 
shield themselves from the accusation of plagiarism; whether in 
reference to points of doctrine or to facts, or whether it applies to 
the language in which the borrowed materials are conveyed. Many 
a reputation, otherwise unassailable, has been greatly stained by a 
single act of literary pilfering. Such acts are of course dishonour- 
able, and should, like every other illicit appropriation, be shunned 
by all men endowed with a proper share of moral sense; and unhesi- 
tatingly exposed by every medical man, who is alive to the honour 



LETTER TO CHARLES D. MEIGS. XV 

and dignity of his profession, and who necessarily feels that the 
commission of such acts must, if frequently repeated, and allowed 
to pass unnoticed, cast a shade over the reputation of the medical 
literature of the country, and make it an object of derision with 
European writers. Far be it from us to affirm that such irregulari- 
ties are not committed on the other side of the Atlantic. Were 
this the proper place, many and curious cases in point might be 
collected from the productions of the English and French medical 
press. But on these we need not dwell. It is sufficient for us to 
guard our own reputation. Depredations of this sort in Europe can 
prove no valid excuse for their commission on this side of the At- 
lantic. Let European writers steal from each other, and from us, if 
they think fit. The theft will disgrace the culprit, but in no way 
reflect injuriously on the medical literature of the country at large ; 
which is too rich in original works of merit to be seriously affected by 
a few transgressions of this sort. But, in the name of all that is manly 
and honourable, let us not lay ourselves open to such accusations. 
"We may doubtless congratulate ourselves that thus far acts of de- 
cided plagiarism have not been exceedingly numerous among us. 
Yet, while doing so, it cannot be concealed that several have already 
been committed; that some occasionally come to light, and that a 
few of those detected are of a barefaced and even monstrous charac- 
ter, and have proceeded from quarters where they might have been 
least expected to originate. Let us hope that such transgressions 
will not be repeated, and that, if repeated, their authors will be ex- 
posed and consigned to the contempt of their professional brethren. 
Too much care cannot be taken to put a stop to such proceedings; 
for their effect on the reputation of our infant medical literature 
must necessarily be of the most baneful character. If the physi- 
cians of this country frequently steal from European writers, or from 
each other, all confidence in their integrity will be lost. He who 
can attempt to deceive in respect to his claims to authorship ; he 
who can stoop to the disgraceful act of purloining the thoughts of 
his brethren; he who reproduces them in the same way and in the 
same words as the rightful owner, without acknowledgment, ex- 
poses himself to the danger of being suspected of dishonest deal- 
ings in all his subsequent literary labours ; while his misdemeanors 
cast a stigma on the professional body to which he belongs, reflect 
injuriously on the scanty literature of the land, and may naturally 



Xvi LETTER TO CHARLES D. MEIGS. 

cause the productions of other and more honest writers to be re- 
ceived with caution, or to be overlooked entirely, lest they also 
may be a transcript of works already known. 

But I have said more than I had intended, and, soliciting your 
indulgence for my loquacity, 

I remain, my dear Doctor, 

Yery affectionately and gratefully, 

Your friend, 

E. LA KOCHE. 

Washington Square : 

January 12, 1854. 



CONTENTS 



CHAPTER I. 

PAGE 

Belief in the connection of pneumonia with autumnal fevers long enter- 
tained. 

Pneumonia common where fevers seldom or never are seen 
Pneumonia not necessarily prevalent where fevers are common 
The two diseases prevail in different seasons .... 
They appear under the influence of opposite winds 
Pneumonia is of yearly occurrence — not always so fevers 
Their altitudinal range is not the same ..... 



CHAPTER II. 

Existence and morbid agency of malaria 101 

The agency of malaria not universally admitted . . . . .110 

Objections made to the agency of malaria, various . . . .112 

The appearance of fever where there are no marshes does not disprove 
the agency of malaria ......... 113 

The non-detection of malaria in the atmosphere no proof of its non- 
existence and agency 116 

Fever not due to the action of any known gases . . . . .118 

Not true that nothing is found in the atmosphere of sickly localities . 120 
Chemists not more successful in discovering other morbid poisons in the 
atmosphere ........... 124 

Nature and condition of fever localities lead to the opinion of the exist- 
ence of malaria .......... 128 

The danger of an attack of fever increased in proportion to proximity to 

such localities 130 

These effects are not due to heat alone 134 

Fevers are not the effects of humidity alone . . . . . . 139 

A high dew-point not sufficient to account for the occurrence of fever . 163 
Heat and humidity combined not the efficient cause of fever . . .168 
Vicissitudes of- temperature will not account for the occurrence of 
periodic fever . . . . . . . . . . .169 

The attack is sometimes too sudden, and follows on too transient an ex- 
posure to infected regions, without appreciable atmospheric vicissitudes, 
to be the effect of these or any other kindred cause . . . .173 

Fever not the effect of a particular electrical state of atmosphere . .177 

2 



xvm 



CONTENTS. 



PAGE 

The preceding facts lead to the belief in a poisonous agent floating in the 
atmosphere .......•••• 177 

The innocuousness of some marshes, and of localities similar to those that 
are sickly, no proof of the non-existence or non-agency of malaria 

The exemption may be explained in various ways 

Elevation 

Degree of heat .... 



Sheltering from the action of the sun 
Free ventilation .... 
Humidity of the soil 



178 
184 
187 
191 
194 
194 
198 



CHAPTER III. 

Existence and morbid agency op malaria, continued ..... 201 

Occurrences on shipboard prove the agency of malaria .... 201 

The cause of fever wafted by winds passing over sickly localities . . 209 
The effects of drying, overflowing, and reclaiming marshy and sickly 

localities, and vice versa, prove the existence and agency of malaria . 220 

The first effects of clearing land, &c. injurious . . . . 221 

Partial draining injurious ......... 223 

Injurious effects of the overflow of land ...... 224 

Bad effects of copious rains followed by great and desiccating heat . 234 

Injurious effects of upturning the earth in hot weather .... 238 

Beneficial effects of complete drainage 244 

As cities enlarge and improve, malarial fevers decrease in them . . 254 
Beneficial effects obtained from the draining of marshes prove the exist- 
ence and morbific agency of malaria ....... 258 

The effects of covering sickly places with water lead to the same belief . 260 



CHAPTER IV. 



Existence and morbid agency of malaria, continued 265 

The effect of the "washing" of sickly places lead to the same belief . 265 
Some forms of malarial fevers resemble diseases produced by putrid sub- 
stances introduced into the circulation ...... 271 

The geological formation of sickly localities, and the plants growing 

therein, &c, lead to a belief in the malarial doctrine .... 273 

Cause more effective near the surface of the earth than at a distance . 274 

Cause of fevers destroyed or mitigated by sanative measures . . 275 

Cause arrested by trees, &c 278 

Fever arrested by removing sources of infection 283 

Fever sometimes connected with the existence of certain fogs or mists . 284 

The atagnant water of marshes injurious to health .... 285 

\ paludal atmosphere enfeebles health ....... 287 

Effect of a paludal atmosphere on the duration of life .... 291 

Cause of fever produces an impress of greater or less strength on all 

placed under its influence m 293 



CONTENTS. XIX 

PAGE 

The cause of autumnal fevers produce an impress on the lower order of 

animals and on vegetables . . . 295 

The great diffusion and mortality of autumnal fevers is explained only on 

the supposition of the cause being a gaseous poison . . . . 298 

Autumnal fevers under the influence of various exciting causes . . 304 
The malarial origin of such fevers confirmed by the violent manner the 

cause often acts .......... 305 

The cause of fever extends its action to the foetus in utero . . . 305 
The cause of autumnal fever appears to be neutralized by the poison of 

some zymotic diseases which have no effect on common complaints . 308 

Cause of autumnal fever antagonistic to that of some other diseases . 310 
Other objections urged against the malarial origin of periodic or autumnal 

fevers 320 



CHAPTER V. 

Pneumonia and autumnal fever compared in reference to their causes, 
mode of progression, symptoms, anatomical characters, and the cir- 
cumstances by which they are influenced ...... 335 

The causes of autumnal fevers and pneumonia are different . . .335 

Causes of pneumonia 347 

Autumnal fevers, if not produced like other zymotic diseases, are localized 
in certain places ; not so pneumonia ....... 354 

The opinion is incorrect, for it leads to the inference that the same cause 
produces diseases differing widely in symptoms and anatomical cha- 
racters 358 

Affinity of morbific and therapeutic agents for special organs not to be 

denied . ....... . . * 359 

Distinctive symptoms and pathological conditions different in pneumonia 
and malarial fevers .......... 361 

Odour of the surface peculiar in some malarial diseases ; not so in pneu- 
monia ............ 370 

The condition of the urine different in the two diseases . . .374 

Anatomical characters different in the two diseases .... 377 

The two diseases differ widely as regards the duration of the process of 
incubation . . . . . . . . , • . . 380 

Process of latency governed by definite laws ...... 387 

In some forms of autumnal fever the susceptibility of the system exhausted 
by one attack — not so in pneumonia ....... 395 



CHAPTER VI. 

Pneumonia and autumnal fevers compared in reference to the powers of 

acclimatization ages, sexes, and races of those affected: prevalence 

of the two diseases at the same time, and in rapid succession, no proof 

of identity 403 

The power of acclimatization does not extend to pneumonia . . . 403 



XX CONTENTS. 

PAGE 

Pneumonia and autumnal fevers affect different races . . . .411 

Difference of susceptibility of the two sexes . . . . . .418 

Difference of susceptibility of the two diseases at different periods of life 421 
Effects of the passions and emotions in the two diseases . . . 425 

The prevalence of the two diseases at the same time and in rapid succes- 
sion no proof of identity ......... 428 

Pneumonia and autumnal fevers are not convertible diseases . . . 433 



CHAPTER VII. 

Pneumonia and autumnal fevers, although independent of each other, as 
regards nature and cause, combine together, and form, like other com- 
plaints, hybrid diseases, which must not be considered as peculiar 

forms of either 437 

Cases of pneumonia marked by symptoms appertaining to autumnal 

fever, are the results of complications ...... 437 

The complication of diseases more or less distinct in their nature, and the 

modifying influence of epidemic over other complaints, are well known 

- to etiologists and pathologists 452 

Diseases arising from various species of malaria mix together and form 

compounds 461 

Diseases due to specific contagious poisons amalgamate together, or with 

other complaints, and form hybrid complaints, or exist together in the 

same subject 465 

Pneumonia, like other inflammations, sometimes assume a periodic type, 

independently of a malarial influence ...... 468 

The success of the anti-periodic treatment in pneumonia — supposing it 

true — no proof of the identity in question ... . 471 

The hypothesis of the identity of pneumonia with autumnal fever not 

supported by facts and solid arguments 489 



PNEUMONIA 



AUTUMNAL FEVERS 



CHAPTER I. 



BELIEF IN THE CONNECTION OF PNEUMONIA WITH 
AUTUMNAL FEVERS LONG ENTERTAINED. 

The idea of a close connection, as regards both causation and 
nature, between thoracic inflammations and malarial fevers of vari- 
ous grades and types, has long been entertained, and continues 
even now to be advocated by writers of respectable standing. 
Casually suggested, or openly avowed and sustained at various pe- 
riods by professional authorities on the other side of the Atlantic, 
it has met with special favour in this country, particularly in our 
Southern and Southwestern States, where it now enlists many 
warm and uncompromising defenders. Singular as it may appear 
to modern etiologists and pathologists, that a connection of the 
kind should have been made the subject of serious consideration 
by our forefathers, and still more, that it should receive the sanction 
of physicians of the present age, it requires but a slight acquaint- 
ance with the medical literature of past and present times, to be 
aware of the reality of the fact. To those who have not directed 
their attention to the subject, a few references to the writings of 
preceding and contemporary authors may not be unacceptable. 

The retrospect, if not otherwise serviceable, may do some good 
by contributing to open the eyes of the modern advocates of this 
belief, to the fact that they are treading on ground already and 
frequently travelled over and as frequently abandoned ; and that, 
consequently, whatever credit they may expect for the ingenuity 
displayed in its support, they must sedulously avoid laying claims 
3 



3-i PNEUMONIA AND 

to originality ; while in the progress of our inquiries, enough, it is 
hoped, will be said to shake their belief in the infallibility of their 
views, and to lead them to turn their attention to objects more 
worthy of serious investigation. I would hope, at the same time, 
to guard unprejudiced readers against adopting without mature 
examination, all that has been or may be said in opposition to the 
independent existence of the aforesaid diseases. 

If we open the records of medicine, and inquire into the views 
entertained at various times respecting the sources of febrile com- 
plaints, more particularly of that variety now classed under the 
denomination of periodic or autumnal, we shall find, that the sup- 
position of their being produced by morbid agencies of a general 
character, but differing materially from the mere changes in the 
ordinary and sensible qualities of the atmosphere to which inflam- 
matory diseases of membranous and parenchymatous parts are 
usually due, may be traced to a very early period, and that, passing 
through successive ages to the present time, it has finally assumed 
the shape of a distinct theory. By some writers they are attributed to 
various mysterious constitutions of atmosphere. Others see in them 
the effects of peculiar conditions of the surrounding medium — certain 
secret influences appertaining in a special manner to each separate 
season. Others, again, speak of exhalations issuing from the bowels 
of the earth ; while another, and more numerous set, refer them to 
miasmata exhaled from organic matter — animal or vegetable, or 
both — in a state of decomposition. But although autumnal fevers 
— remittent and intermittent — were at a remote period, and to this 
day continue to be, considered as the offspring of a distinct or spe- 
cific cause, or of some peculiar modification of ordinary morbific 
agencies, the theory has not escaped opposition. So far from this, it 
is not uncommon to find medical writers of former and even modern 
times, upholding the opinion, that thoracic and other phlegmasia? — 
some forms of them, at least — arise from causes identical with, or 
closely allied to those that give rise to the above-mentioned variety 
of idiopathic fevers ; or rather viewing the latter as often produced by 
causes known to occasion common inflammation and vice versa; and 
as a natural consequence regarding them all as mere modifications of 
one and the same disease. Now, without reverting to the numerous 
illustrations of the latter opinion, scattered through the valuable vo- 
lumes handed down to us by the physicians of Greece and Eome, but 
coming down at once to the seventeenth century, we find that Kamaz- 



AUTUMNAL FEVEKS. 35 

zini ascribes the apoplexies, quinsies, catarrhs, pleurisies, and in- 
flammations of the lungs, which occurred extensively at Modena 
in 1691, to the same unhealthy state of the air, induced by the 
wet condition of the soil and subsequent desiccating action of the 
sun, to which he refers the intermitting fevers of spring, and the 
double tertians and semi-tertians of summer and autumn. In some 
of the epidemics described by others — predecessors and contempo- 
raries of Lancisi — febrific exhalations are represented as giving 
rise to diseases which they call dysentery, apoplexy, rheumatism, 
and peripneumonia. Lancisi 1 himself, in tracing the history and 
progress of an epidemic of rheumatism which prevailed at Rome 
in the year 1709, ascribes it to a like cause. The disease spread 
extensively, contemporaneously with the usual fevers of the sea- 
son. Many of the cases were characterized by inflammation of 
the throat, of the windpipe, the pleura, the lungs, &c, all of which 
are referred to the operation of the same cause which gave rise 
to the fever. The same Lancisi admitted that fevers occasionally 
arise from a cause distinct from miasmal exhalation ; — the ungenial 
north winds, and the intemperies resulting therefrom; the very 
morbid influences which he recognizes as productive of pneumonic, 
rheumatic, and other inflammations. 

By Sydenham, similar views, respecting the pathological aod eti- 
ological identity of the diseases in question, were evidently enter- 
tained. To this eminent physician and accurate observer, the doc- 
trine of the malarial origin of endemic or epidemic fevers does not 
appear to have been known; or if known, to have proved admissi- 
ble. Sydenham speaks, it is true, of exhalations from the bowels 
of the earth, as the productive agent of epidemics ; but, far from 
apportioning them to the production of autumnal fevers exclusively, 
and attributing other diseases to different morbific influences, he 
seems to view them simply as the cause of, or an adjunct, to those 
general modifications of the atmosphere which, under the name of 
medical constitutions and latterly of meteorations, have been the sub- 
ject of so much comment, and to which he refers all epidemic dis- 
eases, whether of a strictly febrile character, or marked by thoracic 
inflammation. He nowhere attributes fevers to a special cause ex- 
haling from the surface of the earth itself, or from extraneous sub- 
stances existing thereon, in the sense referred to by Lancisi and 

1 De Noxiis Pallidum Effluviis, Op. ii. 103. 



36 PNEUMONIA AND 

subsequent writers. His readers will recollect the remarks he 
makes under the head of " Epidemics." There are different con- 
stitutions in different years. They originate neither in their heat 
nor their cold, their wet nor their drought ; but they depend upon 
certain hidden and inexplicable changes within the bowels of the 
earth. By the effluvia from these, the atmosphere becomes contami- 
nate, and the bodies of men are 'predisposed and determined, as 
the case may be, to this or that complaint. This continues during 
the continuance of this or that constitution, which, after the cycle 
of a few years, gives ground and makes way for another. 1 But 
they will recollect at the same time, that the remarks of the En- 
glish Hippocrates applied to epidemics generally, as well to the 
epidemic cough of 1675, with pleurisy and peripneumony, as to 
the continued and intermittent fevers of other years. In all, the 
terrestrial effluvia was supposed to predispose the system to a par- 
ticular form of disease, which other causes, differing but little from 
each other, whatever the characters of the epidemic might be, ex- 
cited into action. They were all, therefore, regarded as closely allied 
to each other with reference to causation. Indeed, we have proof 
enough in the accounts Sydenham gives us of the epidemic consti- 
tutions of various seasons — of 1674-1675, for example — that he re- 
garded the cases of pleurisy and pneumonia, which then occurred, as 
"really and substantially nothing more than peculiar forms" of the 
reigning fever. " Sometimes," he remarks, " it (the fever) attacked 
the head, sometimes the bowels. It everywhere put on the symp- 
toms of the particular part affected. Such was the case till the end 
of October. At that time the weather, which had been as warm 
and as mild as summer, suddenly changed to wet and cold. This 
brought on coughs and catarrhs, which were more numerous than 
I remember them to have been. What, however, is of more im- 
portance, is the fact that upon these coughs supervened the station- 
ary fever of the year ; and this having once taken its hold, increased, 
and varied in some of its symptoms from the fever of the previous 
part of the year. The attack of the previous fever had been chiefly 
determined towards the head and bowels. That of the present was 
towards the lungs and pleura, and as such gave rise to symptoms 
of pneumonia and pleurisy." 2 In 1675, " the coughs paved the way 
to fever, and passed without difficulty into it. Meanwhile, just as 

1 Works, i. 88-4; Ed. of Sydenham Society. 2 /^ £05. 



AUTUMNAL FEVERS. 37 

the coughs helped the constitution in producing the fever, so also 
was the fever determined by the coughs to the lungs and pleura. 
These it attacked just as, a week before, it had attacked the head. 
This sudden change inclined the unthinking to consider the fever 
as an essential pleurisy, or an essential peripneumony. Yet it was 
neither more nor less than what it had been throughout." 1 

Even at a time when, with the progress of knowledge, febrile 
complaints began to be more definitely traced to separate and spe- 
cial causes distinct from those occasioning parenchymatous and mem- 
branous inflammations of the lungs, some authors of repute, from 
whom better things might have been expected, continued to refer 
these — certain forms of them at least — especially when they spread 
extensively, and presented unusual phenomena and a tendency to 
assume a periodic type, to the same agencies as usually give rise to 
epidemic and endemic fevers. Of this we have an example in no 
less a man than Cleghorn, who, in his account of the bilious pleu- 
risy which spread epidemically in Minorca during the latter part of 
1745 and beginning of 1746, and forms the subject of one of the 
most interesting chapters of his invaluable work, expresses himself 
on that matter in terms that can scarcely be misunderstood. 2 

The disease commenced like an ague fit, with shivering and 
shaking ; flying pains ; bilious vomiting and purging, succeeded by 
quick breathing; immoderate thirst; inward heat; headache, and 
fever. It observed a remittent type, and on the third or beginning 
of the fourth day, there was frequently a great remission ; some- 
times a total cessation of every violent symptom. 

But, on the fourth or fifth, the disease was aggravated, and the 
patient expired in a day or two, either suffocated or raving mad. 
In another place, this distinguished observer remarks that "the anni- 
versary epidemical fevers in Minorca may be divided into two classes 
— the summer and winter fevers. The former break out in June and 
July, and cease about January, or somewhat sooner. The latter 
seldom appear before November, and are rarely seen after the 
summer solstice. Both these classes of fevers, and indeed almost all 
others which happen in that climate, whether primary or symp- 
tomatical diseases, may be termed periodical, having remissions at 
intervals more or less considerable. But those of the summer gene- 

' Works, i. 226; Ed. of Sydenham Society. 

2 Observations on the Epidemic Diseases in Minorca, 257-261. 



38 PNEUMONIA AND 

rally assume some one or other of the tertian types, being worse one 
day and better the next, alternately ; whereas, the winter fevers, 
though they often counterfeit tertians, especially in their beginning, 
yet, for the most part, have exacerbations equally strong every day. 
It may likewise be remarked that as the summer fevers are gene- 
rally complicated with fluxes and painful obstructions in the chylo- 
poietic viscera, so are those of the winter with coughs, catarrhs, and 
topical inflammations of the vital organs ; the brain ; the lungs ; 
the heart itself." 

Pleurisy, therefore, according to this view of the subject, is 
nothing more nor less than a modification of marsh or periodic 
fever, or a form of the disease of which common periodic fever con- 
stitutes another form ; the difference between them depending on 
difference of the parts pathologically implicated, and this in its turn 
being due to the difference of the particular atmospheric influence 
giving rise to the disease ; — the cold of winter being the exciting cause 
of the one form, and the heat of summer the exciting cause of the 
form peculiar to that season. Indeed, we cannot discover that Cleg- 
horn anywhere attributes pulmonary inflammations and fevers to 
separate and specifically different causes, or alludes to anything more 
than atmospheric influences, and that he regarded those diseases as 
essentially different in a pathological point of view. As the one 
declines the other appears. The former is the chief among the 
vernal epidemics, as the other is constantly foremost among the 
autumnal. They are, to all intents and purposes, one and the same 
disease ; the only difference being in the local affections that may 
supervene during their course, and by which they may be compli- 
cated ; a diversity itself due to peculiar thermometric changes. 

Long after Cleghorn, Dr. Wells advocated the opinion of the 
existence of a connection between malarial fevers and inflamma- 
tory diseases of the lungs. Whether, however, this connection was 
thought by him to imply the existence of a close pathological and 
etiological alliance or identity, is a question I have not been able 
to find out. It was founded on the circumstance that the two dis- 
eases exist at the same time, or succeed each other; and that those 
who have the one disease in one season, are liable to have the other 
in the next. Thus, Dr. Wells was told by his preceptor, Dr. Gar- 
den, who had practised in South Carolina, that he had found that 
those who suffered severely in the autumn from intermittents, were 
ih'' most liable to pleurisy in the spring. "Dr. Chalmers, another 



AUTUMNAL FEVEKS. 39 

physician of South Carolina {Essay on Fevers), has said that nothing 
more frequently happens in that country than the accession of an 
intermittent a day or two after the removal of a pleurisy. In the 
year 1777, 1 saw the remark of Dr. Garden confirmed in a regiment 
of soldiers, stationed in Guelderland, part of which had been quar- 
tered the preceding autumn in Zealand. In a report made by Dr. 
Blane, Dr. Borland, and Dr. Lempriere, to the British Government, 
in October, 1809, on the sickness of our troops in Zealand, it is 
mentioned, on the authority of the inhabitants, that such of our 
soldiers as had suffered from intermittents in the autumn would 
run the risk of being cut off by inflammatory diseases in the winter 
and spring. No mention, indeed, is made of the particular kinds 
which would then prevail ; but what is said of their fatality, seems 
to show that inflammations of the chest were chiefly referred to ; 
and, at any rate, it is certain that these diseases must have been 
included under the general term inflammatory." Dr. Wells farther 
appeals to Huxham (20), to show that fevers sometimes are rife and 
contemporary with epidemic pleurisies and peripneumonies ; also 
to Cleghorn, for the fact that, at Minorca, pleurisies are generally 
the chief among the vernal epidemics, as tertian intermittents are 
constantly among the autumnal; and, in addition, states, on the 
authority of Drs. Weeks, of Sussex, and Harrison, of Horncastle, as 
well as his own, that, with the decrease of intermittents in some 
parts of England and London, there has been a like decrease of 
pleurisies. 1 

Those who in Italy, England, France, and this country, deny or 
doubt the agency of malaria in the production of periodic fever, 
though not all, so far as I know, going the length of regarding 
pneumonia and other thoracic diseases as nothing more than pecu- 
liar forms of such fevers, cannot but believe in their close alliance 
with these, viewing, as they do, the latter as proceeding from the 
agency of much the same causes as occasion the former. " That a 
residence in marshy countries, says one of these writers, subjects to 
intermittent fevers, is an undeniable fact ; and that they who live 
on broken, hilly districts, are liable to pulmonary diseases is also 
unquestionable. If locality explain the latter, it may equally ex- 
plain the former, without recurrence to imaginary agencies. In the 
same county of Lincoln, in England, the inhabitants of the fens are 

1 Trans, of a Soc. for the Improvement of Med.-Chir. Knowledge, iii. 537-9. 



40 PNEUMONIA AND 

sufferers from intermittent fevers ; those of the wolds or hills, are 
obnoxious to catarrh, pleurisies, and phthisis. If an exchange be 
made of habitation in those two cases, there will be exchange of 
diseases. Why then demand miasm as a cause of fever, and refuse 
it as a cause of pulmonary disorders ?" 1 As the writer regards au- 
tumnal fevers, from the simple intermittent to the malignant yellow 
as produced by heat, cold, humidity, atmospheric vicissitudes, and 
the like, and as he cannot attribute pulmonary inflammation to other 
agencies, it follows that, according to him, the same causes may give 
rise to both sets of diseases, which hence, cannot differ essentially in 
a pathological point of view. 

Dr. Eush and his disciples may not always have said, in positive 
terms, that pneumonia, pleurisy, and other kindred affections, are 
really and substantially peculiar forms of periodic fever, and no- 
thing more ; — they may not have attributed them all to the same 
morbid agencies ; but in upholding the doctrine of the unity of 
disease, and the applicableness of the same treatment — modified 
only in point of energy, and as regards the use of particular means, 
by the condition of the system at large, and the nature of the 
parts affected — they admitted the pathological identity of pneumonia 
with periodic fevers, considering them both as constitutional dis- 
eases, which assume different forms according to the nature of the 
local derangements by which they may be accompanied, but remain 
always fundamentally the same. Hence we find that eminent phy- 
sician remarking: "There is but one exciting cause of fever, and 
that is stimulus. Heat, alternating with cold, marsh and human 
miasmata, contagion and poisons of all kinds, intemperance, pas- 
sions of the mind, bruises, burns, and the like, all act by a stimulating 
power only, in producing fever. This proposition is of great appli- 
cation, inasmuch as it cuts the sinews of the division of diseases 
from their remote causes. Thus it establishes the sameness of a 
pleurisy, whether it be excited by heat succeeding cold, or by the 
contagion of the smallpox and measles, or by the miasmata of the 
yellow fever." "There is but one fever. However different the pre- 
disposing, remote, or exciting causes of fever may be, whether de- 
bility from obstruction or action, whether heat or cold, succeeding 
to each other, whether marsh or human miasmata, whether intern- 
Iterance, a fright, or a fall, still, I repeat, there can be but one 

1 Bell on Miasm. Philadelphia Med. and Phys. Journ. ii. 316, N. S. 



AUTUMNAL FEVERS. 41 

fever." 1 A little farther on, he makes several forms or states of 
fevers. Of these, the eighteenth is the pulmonary, which includes 
true and bastard pneumony, acute and chronic catarrh, etc. 

Morton, Lauder, Sauvages, Alibert, Mongellaz, ChaufYard, Com- 
paretti, Gouzee, Daniell, Evans, Abloing, Brera, Matthei, Bailly, and 
others, to whom I shall again have occasion to refer, describe a 
pneumonic form of intermittent fever, or periodic form of pulmonary 
inflammation, produced by the same cause as ordinary intermittents, 
and thereby, like the preceding writers, acknowledge the identity 
of both sets of phenomena represented in the compound. 

Not very different were the views of the late Dr. Kobert Jackson, 
of the English Army, whose writings on the yellow fever of the 
West Indies, and South Coast of Spain, as also his volumes on the 
remedial effects of cold affusion in febrile diseases and on contagious 
fevers have enjoyed, and continue to enjoy, a merited reputation. 
Fever, according to this distinguished author, is a form of changed 
or perverted organic action, "that is, a new form of life impressed 
on the minuter series of organic capillaries, varied in expression 
according to the varied structure of the series upon which the act 
is principally manifested." "The diseased act is liable to change, 
or to suffer transfer from one series to another, in various ways 
and manners, and at various points of time ; and thus to exhibit 
within the limit of the total duration, a scene of fluctuation and 
uncertainty which is more or less embarrassing to the observer." 2 
After stating that he considers endemic fever, whether it appears 
in the torrid or temperate zones of the earth, to be radically one 
disease, he remarks: "As the act, whether progressive or re- 
gressive, varies under contingencies, so it changes mode, or 
suffers transfer from one series to another at certain periods of its 
course, to such an extent and in such manner as to appear totally 
unlike itself. The modes of febrile action are, as now observed, 
numerous, and, as superficially varied, totally unlike one another. 
The author considers them as resting on a common base, conse- 
quently as one disease." So much for endemic fevers — the cause has 
the same base in all parts of the earth, modified by circumstances 
of locality in different districts of similar latitudes, so as to present 
considerable diversity of appearance in its visible operation. It is 

1 Outlines of the Phenomena of Fever, Works, iii. 9, 10. 

2 A Sketch of the History and Cure of Febrile Diseases, i. 10, 11, 15. Lond. 1820. 



42 PNEUMONIA AND 

also modified by elevation, exposure, and the revolution of seasons, 
circumstances of subjects, &e. Farther on, Dr. Jackson says: "The 
outline of the history and cure of fever, which is given in the pre- 
ceding pages, applies to fever as a disease of the organic system 
acting on a general base. Fevers, I am aware, rarely occur at any 
time, where some one part does not suffer more prominently than 
others in all stages of the course ; but the term general is here affixed 
to that form of the disease where the predominance is fluctuating 
and contingent; local, where it is prominent at the commencement, 
and where it continues uniformly prominent throughout. The 
cause which produces inequality in the force and mode of the per- 
verted movements, which are excited by the action of the cause of 
fever in the different organs of the system, is necessarily obscure. 
I do not pretend to explain it, and I only take leave to suggest, that 
it is apparently connected with the unequal condition of organic 
sensibility existing at the time the morbid cause is applied, or that 
it explodes into action ; a condition constitutional or contingent, as 
depending upon the operation of general or contingent causes to 
which the movements of animal life are exposed." 1 

We have, then, according to this view, fevers, which are diseases 
of the whole system, without determinate and permanent local de- 
terminations ; and fevers also of the whole system, but which, un- 
like the former, manifest their action more permanently in particular 
organs : among the latter, we have the forms of fever located in the 
inferior or abdominal cavity ; the gastric, choleric, dysenteric. The 
forms of fever with local action in the superior or cranial cavity ; 
the forms of fever with local disease in the organs of the thoracic 
cavity — the pneumonic, the cardiac, and catarrhal ; and the forms 
of fever with external local action — the ophthalmic and ulcerative. 
All these forms are produced by the same causes, though some are 
more particularly noted to owe their origin to exhalations from the 
soil, more generally or more partially diffused ; all are mere modi- 
fications of one and the same disease. 

"The pneumonic," adds Dr. Jackson, "is an important, and, in 
some countries, a frequent form of the action of a febrile cause. It 
is more common, according to the laws of the annual revolution, in 
BOme Beasons of the year than in others; and it is sometimes epi- 
demic in Beasons and places to which it does not seem to belong. 

1 Op. cit. Li, 1, 2, &o. 2 mdt p> 83> 



"2 



AUTUMNAL FEVERS. 43 

If anything were required to show that all those febrile diseases 
with local determinations were placed by Dr. Jackson on the same 
footing, pathologically and etiologically, with the non-local forms, 
it might be derived from the fact that, while including, as we have 
seen, dysentery and some other complaints among the former, he 
remarks, after stating that on plains near the sea-coast, muddy rivers, 
bayous, and other foul grounds, the product of the cause is usually 
remittent, sometimes intermittent: " The action of the morbid cause, 
instead of being what is commonly called febrile, is not unfre- 
quently dysenteric; sometimes eruptive and ulcerative on dry, 
bare, rocky, and hilly positions near the sea-coast, or in positions 
where water flows with a rapid course." 

Dr. Macculloch, 1 though furnishing no proof of the correctness 
of his opinion, and admitting that, of very much of what he states he 
has no personal knowledge, includes among the diseases produced by 
malaria, and which consequently he considers as mere modifications 
of the legitimate products of that cause, angina, asthma, oedema of 
the lungs, and catarrh reaching to peripneumony. Copland, in his 
article catarrh, 2 echoes Macculloch, so far, at least, as the latter 
disease is concerned, and, under another head, refers catarrhal fever 
to the same cause as intermittents, enlarged spleen, torpid states of 
the liver, and rheumatic attacks, i. e. to "miasms from decayed 
vegetable matter, aided by moisture, in temperate ranges of atmo- 
spheric heat." 

An intelligent writer of our own country, the late Dr. Yaughan, 
of Wilmington (Delaware), in an Essay on the diseases of that 
State, alluding to those of winter and spring, remarks that a respite 
is then obtained from the attacks of ague, and a new order of dis- 
eases arises from sudden transitions of temperature. The general 
character of the prevailing complaint is peripneumonia notha, in the 
majority of cases ; but too much stress, he thinks, is laid on the 
local affection, and too little on the general state of the system ; and 
he farther maintains that, from the state of the pulse, the frequent 
sighing in respiration, the tendency of the fever to assume a tertian 
type, the early appearance of the hippocratic countenance, "it be- 
longed to the genus of autumnal fevers, varied by the casualties of 
the atmosphere." " It may be said that this is too far strained, and 
that frost destroys marsh miasmata as a tropical plant. Granted : 

1 On Malaria, 442. * y i. i. 2 72. 



4-4 PNEUMONIA AND 

when the ponds are covered with ice, exhalation is overpowered ; 
but if these fevers suffer a common fate with their causes, why do 
intermittents exist or occur in winter, and winter quartans, the most 
obstinate of the whole tribe? Why do valetudinarians suffer re- 
lapses in the frosts of January and February ? And why are per- 
sons on a removal from a marshy to a high country attacked with 
the endemial fevers of the fens, if the remote cause be not dormant 
in the system, and excited into action by a concurrence of predispos- 
ing causes? These facts, I presume, substantiate the position that 
our winter diseases are but varied forms of the autumnal fever." 1 

In an account of the diseases which occurred at Fort Gibson (Ar- 
kansas), during the last quarter of 1833, Dr. Forry states, on the 
authority of Dr. Pitcher, and Dr. Wharton, of the army, that most 
of the cases — pleurisies, cholera, rheumatism — partook of the inter- 
mittent character, and adds : " The strict periodicity of these affec- 
tions, and their subjection to the same remedies which are found to 
arrest the course of intermittent fever, imply a close alliance, if not 
a common origin." 2 

We might embrace, in this category, no less an authority than 
Broussais, and even the greater number of his more enthusiastic 
disciples ; for, with them, all fevers, whether of a continued, remit- 
tent, or intermittent type, are nothing more than so many varieties 
of one and the same pathological condition; inflammatory irritation 
having its seat in one and the same tissue — the gastro-enteritic mucous 
membrane. This gastro-enteritis, with the various complications 
that may supervene, are, they say, produced by the action of cold 
alone, or, as is more frequently the case, combined with humidity, 
or through the agency of atmospheric vicissitudes ; or, as regards 
some forms of the disease, of malarial exhalations. But, whichever 
of these may be the efficient agent— heat, cold, humidity, vicissitudes, 
or malaria — the effect is the same. It is always gastro-enteritis, 
whether with or without the addition of inflammatory irritation in 
other organs or tissues. There is nothing specific in the cause, 
and, as a natural consequence, nothing specific in the effect which 
that cause produces. Heat, cold, malaria, may go a different way 
about it, but the change they induce in the system is similar, and 
that change is effected in the gastro-enteritic mucous membrane. 
One or other of the pyrexias is the consequence ; the difference be- 

1 New York Med. Hepos. iv. 130. 2 climate of the U. S. 186. 



AUTUMNAL FEVERS. 45 

tween them being due to a variety of concomitant circumstances, 
connected with external influences or personal peculiarities. Pneu- 
monia, and other inflammations, parenchymatous, serous or mucous, 
differ in nothing from the other form of disease ; they are, it is true, 
more frequently produced by cold and atmospheric vicissitudes than 
by malaria. But the effect, after all, is only inflammation; and, as 
the latter presents nothing specific in its character, whatever be 
the part it may show itself in, it follows that these diseases differ in 
nothing from the former mentioned, except as regards the parts 
inflamed ; the difference being due to the mere circumstance that, 
at the approach of winter, or during the prevalence of atmospheric 
vicissitudes, the thoracic organs take on more readily the inflam- 
matory action, while at other periods the gastro-enteritic apparatus 
is more frequently affected. 

More recently, Dr. H. A. Eamsey, of Eaysville, Geo., in an Essay 
on Pneumonia, published in the early part of 1851, has advanced 
much the same views, regarding the disease as the product of the 
same causes as occasion intermittents, and hence, as identical 
with these. 1 And at a still later period, Dr. A. P. Merrill, Pro- 
fessor of Materia Medica and Therapeutics, in the Medical School 
of Memphis, Tenn., in an Essay on Pneumonia, originally inserted 
in the number for July, 1851, of the New Orleans Med. and Surg. 
Journ., but more recently issued in pamphlet form, conjointly 
with two other essays, has adopted a similar theory, relative to 
the connection in question. Asserting it more positively, and with 
much greater distinctness than has been done by the generality of 
modern writers, and regarding it as fully sanctioned by the results 
of a long experience, acquired in the South, he lays down as an 
indisputable fact, that pneumonia, though sometimes appearing as ' 
an idiopathic affection, is most generally — whether it prevail spora- 
dically or as an epidemic — really and substantially nothing more 
than a peculiar form of remittent and intermittent fever, in which 
the lungs, from sudden transitions of temperature, are made to bear 
the burden of local disease. 

Other authorities, equally respectable, both at home and abroad, 2 

1 A Practical Essay upon the Symptomatology, Etiology, Vital Statistics, and 
Treatment of Pneumonia. — Charleston Medical Journal and Review, vi. 1, etc. 

2 Baronius, Pleuro-pneumonia, Ann. 1633. Bovillat, Mem. sur les pleuro-pneu- 
monies epidemiques, 556. Good, Study of Med. ii. 424. Hugh Williamson, Med. 
Register, iii. 453. Boott, Life of Armstrong, ii. 41, 290-1, 416. Yates, an Essay on 



46 PNEUMONIA AND 

might easily be found, to swell the list of the advocates of the views 
in question ; but the preceding will amply suffice to show that these, 
whether having reference to a few exceptional cases of pneumonic 
inflammation, or to the disease as it appears always and every- 
where, and as it presents its legitimate characters, have long enlisted 
the attention of medical inquirers, and continue to enumerate warm 
supporters. 1 

When we come to inquire into the grounds upon which the 
opinion of this close alliance or identity, both as regards the patho- 
logy or etiology of those two classes of diseases is predicated, we find 
that, with the exception of Sydenham, according to whom the differ- 
ence of one epidemic disease from another depended on a variety of 
atmospheric constitutions, and who contented himself with describing 
the symptoms, progression, &c. of the complaints he observed and 

the Bilious Fever prevailing in the State of New York. Albany, 1813, p. 27. Med. 
and Phil. Register, iii. 488. Sarcone, Histoire Raisonnee des Maladies Observees 
a Naples pendant le cours en tier de l'Annee 1764, i. 124-202. 

1 A writer in one of the Western Medical Journals [Ohio Medical and Surgical 
Journal, i. 508) remarks, that Malaria, besides giving rise to all varieties and species 
of acute febrile disorders — from the highest sthenic to the lowest asthenic grade, 
induces many obscure and anomalous forms of disease, and frequently imparts 
new features and tendencies to every disorder that may come within the sphere 
of its influence. That it makes its impressions primarily on the cerebra spinal 
system, can hardly, as he thinks, admit of a doubt. The morbid impression there 
made may be transmitted to the extremity of the nerves taking their origin in that 
system, and there develop its evidences, in the form of some functional or organic 
derangement. "The viscera of the chest, abdomen, and pelvis, and the fibrous 
cellular tissues, may in this way become the seat of disease, from reflected malarious 
impressions. Such cases are common. Many affections of the heart, stomach, intes- 
tines, and liver, and in females uterine disorders, are of this character. They have 
been imperfectly recognized and described by authors as "Irregular and masked In- 
termittent," "Complications," &c. This exciting cause may restrict its action solely 
to the nervous system, and has been known to originate or complicate with every 
species embraced in Cullen's class Neuroses, from Apoplexy down to Hysteria. In 
other instances, it may take a wider range, and show its effects under the forms of 
irritation, inflammation, and I might properly add, every disorder to which the human 
family is subject." In all cases of malignant erysipelas that have come within the 
experience of this writer, "it has participated largely, either as an exciting or modi- 
fying cause." To the Western physician, it is added, under whose observation malaria 
is daily producing such effects, their diagnosis is often a source of perplexity ; while 
to the members of the medical profession in the Eastern States, "avIio know nothing 
of such diseases, except from books and lectures, it is a perfect stumbling-block." 

The writer of these remarks is Professor of Physical Diagnosis and Theory and 
Tract ice of Medicine in a Western medical college. 



AUTUMNAL FEVEBS. 47 

troubled himself very little about their pathological or phenomenal 
relationship ; and of Dr. Kush, with whom the idea of the alliance 
in question was the natural offspring of his doctrine of the unity of 
diseases ; most of the writers we have cited, from Cleghorn down- 
ward, dwell on the circumstance, that the two diseases — periodic 
fever and pneumonic inflammation — are found to prevail simultane- 
ously in the same localities, or to succeed to each other ; that while 
pulmonary inflammation often occurs in summer and autumn, when 
fevers are rife, so the latter — even intermittents — appear also in 
winter and spring, when the former usually prevails extensively. 

"With Dr. Eamsey, whose observations were principally made 
during an epidemic of pneumonia which swept over Lincoln 
County, Georgia, in 1845, the proof lies principally in this: that 
families Y/ho have been formerly healthy at other points, become 
affected by intermittent, febrile, and pneumonic diseases, by moving 
to a malarious location, and subsequently healthy by removing from 
it ; that on that remarkable occasion, when out of a population of 
seven thousand, three hundred died of the disease, and when out of 
one hundred and seventy cases he attended it was his good fortune 
"not to have sustained the loss of a single one," most of the cases 
occurred along the course of the streams, and at those points which 
rarely escape chill and fever ; that when it occurred elsewhere it 
could be accounted for by the fluctuations of the seasons, manure- 
piles, swamps, &c, which then and now exist throughout the country 
to a greater or less extent, " carrying with their effluvia, through 
the medium of the winds, the emanations of disease (pneumonia of 
course among these) and the seeds of death," and that, in ordinary 
times, "those who make most manure, and have their lots closest to 
their houses, have most cases of pneumonia." Pp. 12-16. 

Dr. Merrill, who has recently taken a leading part in the defence 
of the opinion in question, and who, on more accounts than one, 
deserves to be listened to with respect, on this or any other subject 
connected with the diseases of our Southern States, rather boldly 
assumes the point, than attempts to prove it, and remarks : " These 
fevers occupy the attention of the physician, in some of their vari- 
ous shapes, at all seasons of the year, both in town and country ; 
and they have been characterized, at various times and in various 
places, by a great multiplicity of names." Again : " This protean 
character of our fevers arises in part from the season of the year, 
and the localities in which they occur ; but mainly from the organs 



48 PNEUMONIA AND 

of the body which, become involved in the diseased action, the pre- 
dominance of inflammation or congestion, and the character of their 
periodicity. In the spring we are apt to rind these diseases assuming 
names which have reference more particularly to this periodicity 
and general pathology. As summer comes on, the greater implica- 
tion of the hepatic organs changes the name, or adds an epithet to 
designate a prominent symptom. In autumn, the chylopoietic 
viscera become more strikingly involved in the diseased action, and 
this again is indicated by an ever-changing nomenclature. But when 
winter approaches, and the subjects are exposed to sudden transi- 
tions of temperature, the thoracic viscera are called upon to bear 
the burden of local disease, and then it is that the names pleurisy, 
pneumonia, pneumonia typhoides, pneumonia biliosa, pleuro-pneu- 
monia, bilious pleurisy, lung fever, etc., become familiar." 

After a pointed allusion to writers of books on the practice of 
medicine, and teachers who " find a complicated system of noso- 
logy a very convenient loop upon which to hang their learned dis- 
quisitions;" as well as to physicians in practice, who "derive advan- 
tage from an exercise of ingenuity and tact, in suiting the names of 
prevailing diseases to the phases of popular prejudice, and in ex- 
plaining their want of success, without implicating the infallibility 
of their skill ;" and also to the erudition displayed in arranging the 
nosology of " Southern fever into forty or fifty different varieties, 
deriving a technical name for each of them, from the classical lore 
of the schools, and from the more vulgar vernacular of modern 
tongues," etc., Dr. M. adds: "Let us talk as learnedly, and refine, 
discriminate, and vary our nomenclature as we may, to suit the 
fashion of the times, when we come to deal with plain facts, as they 
are presented to us in practice, this whole class of diseases to which 
I have here alluded will be found to take its appropriate place 
under the plain designation — periodic fever. "We know very little 
of the causes which produce it ; but we meet with it every month of 
the year, and generally it varies in appearance and symptoms only 
as it varies in degree of violence, and as the different organs of the 
body become more or less implicated. Now it so happens, and we 
need not attempt here to give the reasons why, that the stomach 
and brain become more involved in the diseased action in summer, 
and the lungs and the other thoracic contents, in winter." "These 
local affections, whichever may for the time predominate, do not, in 
any material respect, change the character of the constitutional dis- 



AUTUMNAL FEVERS. 49 

ease, it is a periodic fever still, and requires the anti-periodic treat- 
ment." "In all its forms and modifications, we can never lose sight 
of the important fact that the disease is one of periodicity and self- 
limitation. Its uniform paroxysmal character points to the use of 
one great remedy, upon which, in all cases, whenever (wherever?) 
the local lesion may appear, we must place our main dependence 
for relief," care being taken, however, to remove those lesions by 
appropriate means. 

All this is plain enough, and leaves no doubt as to the import of 
the views under examination, of the principal grounds on which 
they are founded, and of the mode of practice to which they are 
intended to lead. Pneumonia must, henceforward, be classed among 
the various diseases which, from a peculiar phenomenon they exhibit, 
and the peculiar treatment they call for, take their appropriate place 
under the plain designation of periodic fever. Pathologists, opening 
their eyes to the light once more shed upon the subject, must cease 
to consider pneumonia, except in a few cases, as an idiopathic disease 
separate from and independent of all others. They must learn to 
view it as only deform of another complaint ; in other words, as a 
periodic fever in disguise. Its occurrence at the same time, and 
in the same place with periodic fevers ; its succeeding to or pre- 
ceding these ; its presenting periods of exacerbation and remission, 
and its being benefited, when these fluctuations occur, by remedies, 
quinia particularly, which exercise an anti-periodic power, establish 
beyond the possibility of doubt the important fact of the close alli- 
ance between, if not common origin of, those diseases. All the 
diseases so classed, pneumonia, pleurisy, pneumonia typhoides, 
pneumonia biliosa, as indeed, hepatitis, phrenitis, gastritis, are pro- 
ducts of the same causes that occasion remittent, intermittent, yel- 
low fevers, plague, Asiatic cholera, and typhoid fever — the difference 
depending on temperature, atmospheric vicissitudes, and the like. 1 

1 In former publications, l Dr. Merrill has expressed the opinion that yellow fever 
differs in nothing but degree of violence from the common autumnal remittent, 
and arises from precisely the same causes. I need scarcely remark that many others, 
in this country and elsewhere, have entertained, and continue to entertain, similar 
views on the subject. For this reason, and because, while discarding all such opinions 
relative to the pathological and etiological unity of these two forms of fevers, I regard 
yellow fever, as also common autumnal fevers, as the products of aerial poisons — the 



i "Yellow Fever of Natchez," in 1823, Philadelphia Med. and Phys. Journ. vs.. 235 ; "Yellow Fever of 
Natchez," in 1825, N. A. Med and Surg. Journ. ii. 217. 

4 



50 PNEUMONIA AND 

Autumnal fever-— it is argued— being met with every month of 
the year, the cause, whatever it may be, must exist all the year 
round, uninfluenced, in regard to its creation or disappearance, by 
changes of season, atmospheric phenomena, etc. Like every other 
form of fever, pneumonia must be viewed as a general disease of 
the whole system, but evincing a strong determination of diseased 
action to some particular organ — in the instance before us, to the 
lungs — the difference depending on season, weather, and other kin- 
dred circumstances. These local affections, whichever may for the 
time predominate, do not, in any material respect, change the cha- 
racter of the constitutional disease — it is a periodical disease still, 
and requires the anti-periodic treatment. The pneumonia of all 
writers is, strictly speaking, only the pneumonic form of periodic 
fever ; and while we are devoting our best skill and energy to 
relieve the local affection, we must not lose sight of the fact that 
we are dealing with a constitutional complaint — a periodic fever. 
Though it cannot be denied that pneumonia sometimes appears 
among us, as an idiopathic affection, we are justified in concluding 
that the thoracic inflammations, which show themselves in this 
country generally, sometimes sporadically, and frequently with epi- 
demic violence, are really and substantially nothing more than a 
peculiar form of intermittent and remittent fever. In a word, pe- 

results of local infection — of kindred though not identical nature, I shall, throughout 
these pages, treat of them all under the generic name of malarial diseases. They all 
belong to that family of zymotic diseases (those due to morbific ferments), which, 
unlike others of the same class, which are due to contagious viruses, arise from local 
sources of infection ; in other words, in which the morbific emanations in connection 
with which they arise, act not only as predisposing, but as exciting causes also. The 
admission that these diseases belong to the one class of zymotics and arise from fer- 
ments, by no means necessarily carries along with it the idea of pathological identity. 

For similar reasons I may occasionally refer to typhoid fever in connection with the 
cause of the former, for that disease would appear to arise, sometimes at least, from, 
or to be associated in its production or propagation with, morbid agencies somewhat 
allied to those from which autumnal fevers generally spring. Besides it is viewed, 
with what degree of propriety I shall not stop here to inquire, by some of our South- 
ern physicians, to say nothing of some few in the North, and a small set in England, 
as only a peculiar form — the continued — of common autumnal fevers, and not as a 
special and specific disease. 

Finally, I shall, for the same reason, refer to the oriental plague as a malarial dis- 
ease ; for it is not unusually acknowledged, by high authorities too, to arise or to be 
greatly under the influences of exhalations of a malarial character; and is, besides, 
regarded by some writers of this country more particularly as another form of common 
remittent autumnal fevers. 



AUTUMNAL FEVEES. 51 

riodic fever is a protean disease, which sometimes, owing to sundry 
adventitious circumstances, attacks one set of organs, sometimes 
another. When it exercises its deleterious influence on the pul- 
monary organs, it gives rise to their inflammation or congestion, 
and occasions the disease we denominate pneumonia, pleurisy, etc. 
But, whatever be the part affected by it, it is always the same con- 
stitutional disease, and invariably calls for the same general treat- 
ment. Medical writers and medical teachers may amuse themselves 
in classifying diseases according to their supposed differences in 
regard to seat, phenomena, and nature ; they may exercise their in- 
genuity and tact in suiting the names of prevailing diseases to the 
phases of popular prejudice ; or display vast erudition in discrimi- 
nating the different varieties of southern fevers, and arranging their 
nosology; they may prate about these matters as much as they 
please, but, by so doing, they only afford the proof that they have 
not carefully imbued themselves with the principles of the Baconian 
philosophy, and that their whole system, of the pathology, practice, 
etiology and physiology of fevers and febrile affection is erroneous 
— founded on preconceived notions, and not upon facts and induc- 
tions. For it is now proved, to the satisfaction of a few observers, 
more sharp-sighted than the very large majority of their brethren 
in both hemispheres, that this whole class of diseases takes its ap- 
propriate place under the plain designation, periodic fever ; that all 
the varieties of that class, which, for certain reasons, well known to 
the reader, have been held, heretofore, as distinct from each other — 
typhus, typhoid, intermittent, remittent, yellow, etc. — are really 
and substantially one and the same disease, and that in the same 
category must now be placed pneumonia, pleurisy, etc. 

Such are the views entertained to some extent in former days, 
and revived on a rather more extensive scale in recent times, rela- 
tively to the close affinity or the identity — pathological and etio- 
logical — of two classes of diseases which the profession generally, 
both here and elsewhere, have found ample reason to regard as 
totally distinct from, and independent of each other. Examined 
in whatever point of view we please, analyzed as closely and 
minutely as it is in our power to do, the whole argument in 
favour of those views — setting aside what flows from: the peculiar 
theoretical notions of some of their advocates relative to the unity 
or relationship of all diseases — and stripping it of all the hors d'ceuvres, 
and hypothetical assumptions, and doubtful assertions by which it is 



52 PNEUMONIA AND 

accompanied, and to a great extent disfigured, the opinion in ques- 
tion resolves itself always into a very narrow compass, and is found 
to rest on a few points already referred to. It may be stated thus: 
the two classes of diseases, pneumonia and autumnal or periodic 
fevers, prevail either simultaneously or consecutively in the same 
locality — conclusion: they must be due to the operation of the same 
causes, and therefore are identical in nature. The periodic element 
is more or less strongly marked in the various grades of autumnal 
fevers; the same element is sometimes detected in pneumonia — con- 
clusion : the latter disease — to say nothing of many others of the 
same class — whether it shows itself sporadically or epidemically, is 
really and substantially nothing more than a peculiar form of remit- 
tent and intermittent fever. Pneumonia sometimes yields to the 
action of the same remedies which are found to check the course of 
autumnal or periodic fevers — conclusion : the similarity of results 
obtained from the same treatment in both classes of diseases, implies 
a close alliance between them, or, indeed, a common origin and 
pathological identity. Pneumonia must be viewed as a general 
disease of the whole system, but evincing a determination of morbid 
action to the lungs; the same may be said of autumnal fevers, 
with the exception that the local determination takes place in some 
other part — conclusion: both these classes of diseases being coDsti- 
tutional, and the difference of the local effects depending on fortui- 
tous and secondary circumstances, they are produced by the same 
causes, and are identical in nature. 

It is evident, from what precedes, that the modern advocates of 
the theory, or rather hypothesis in question, for it scarcely de- 
serves the name of theory, may fortify their cause by an appeal to 
the imposing phalanx of authorities above referred to. No one 
will deny that among these several are found who are entitled, 
for many reasons, to the unbounded regard of the profession at 
large, and are destined to occupy an honourable position in the 
annals of our science. Neither can we doubt that others among 
them — perhaps a large number — deserve to be treated with courtesy, 
manifesting, as they generally do, practical good sense, a commend- 
able amount of professional attainments, and no inconsiderable share 
of ingenuity and smartness. But however numerous the advocates 
of the hypothesis undoubtedly are, and whatever may be the degree 
of respect to which their opinions on this and other subjects is enti- 
tled, it need scarcely be observed that, in what has been adduced 



AUTUMNAL FEVERS. 53 

in its support by them, we cannot discover sufficient reason to acqui- 
esce in its correctness ; while the circumstances under which some 
of the writers quoted were placed, and the opportunity for accurate 
observation and close and careful induction, and the degree of pro- 
fessional scholarship possessed by others, were not such as to ren- 
der their verdict- on pathological and etiological points beyond the 
reach of criticism, and to silence opposition on the part of sub- 
sequent inquirers. Some, and perhaps the most distinguished, 
flourished at a time- when pathological and etiological knowledge 
was at too low an ebb to induce us to look to them for the settle- 
ment of questions of the kind. Others, though living at a period 
less remote from our own, do not appear to have sufficiently quali- 
fied themselves by diligent inquiry, and extensive and close study, 
to justify their pretensions to enlighten the medical world on sub- 
jects of this nature ; while others, again, who recently have thought 
fit to revive the hypothesis, have evidently taken but a one-sided 
and contracted view of the matter, and allowed themselves some- 
times to be swayed in their inferences by favourite and fanciful 
hobbies. 

Under such circumstances the subject might, and perhaps ought 
to have been allowed to drop. But the importance of the question 
thus raised ; the stir it has occasioned among the physicians of some 
sections of this country, and the fair professional standing of some 
of its modern supporters, have induced me to investigate it with all 
the care and attention of which I am capable. The result of this 
investigation has been unfavourable ; and so far from leading me to 
lend a willing ear to the connection under consideration, has only 
tended to confirm me in the opinion I have always held on the sub- 
ject. It has done more ; for I have thereby been induced to adopt 
conclusions diametrically adverse to those of which I have pre- 
sented an outline. Now, more than ever, I regard these as faulty 
in a scientific point of view, and leading to pathological deductions 
not only erroneous and at variance with long admitted principles, 
but occasionally glaringly illogical. I hold them to be in direct 
opposition to facts which are, or ought to be familiar to every ob- 
servant and well-read physician. I hold them to evince a total 
oversight of all established opinions respecting the causes of the 
several diseases thus placed in juxtaposition. I hold also that, how- 
ever plausible these conclusions may seem to be, they have not been 
supported, as far as I can perceive, by a single fact or argument 



54 PNEUMONIA AND 

calculated, when properly sifted, to satisfy a careful inquirer, and 
to which a ready answer may not be found. I hold all this ; and 
see, with regret, that the whole subject has been presented in a man- 
ner evincing a decided disposition to set at naught, as worthless, 
the observations and inferences of all preceding and contemporary 
writers who entertain adverse views, and not unfrequently in a tren- 
chant and contemptuous tone, from which none, not even those 
whom the medical world has never ceased to treat with courtesy, 
and view in the light of standard authorities, are allowed to escape. 
For these reasons, and considering also that these opinions are likely 
to lead, if adopted and acted upon, especially by inexperienced 
physicians, to a hazardous practice ; bearing in mind, besides, that, 
from the influential position which some of their advocates occupy, 
there is reason to fear they may continue to make converts, not 
only among medical students, but among that class of professional 
readers — unfortunately too large among us — who are easily seduced 
by real or supposed novelties, and fanciful or whimsical notions ; and 
convinced, in addition, of the necessity of ascertaining, without loss 
of time, the value of dogmas bearing directly or indirectly on prac- 
tical points, when presented and enforced by men of note and repu- 
tation, I propose to devote this volume to a survey of the facts and 
arguments that may be adduced, and thus to test, in its various 
details, the hypothesis to which attention has been called, and see 
how far it is deserving of our adoption. 

The reader will easily perceive that, before the advocates of the 
identity of the two diseases can successfully sustain the position 
they have assumed, it will be necessary for them to show that au- 
tumnal fevers and pneumonia are produced by the same causes ; 
that they prevail in the same places, and during the same seasons 
of the year ; that their existence and diffusion are promoted by the 
same agencies ; that they are arrested by similar means ; that they 
exercise their effects on the same classes of individuals ; that they 
present similar or kindred symptoms; that they affect the same 
organs, and produce the same or analogous changes in the fluids 
and solids ; that they are governed by the same laws ; and that they 
present other points of approximation invariably found to be pos- 
sessed by diseases between which there exists the close connection 
claimed in the instance before us. Unless they can succeed in 
attaining these objects, their opinion must fall, and the independence 
of those diseases be admitted. It becomes necessary, therefore, 



AUTUMNAL FEVERS. 55 

to take up each of those subjects separately, and to ascertain how 
far they may be appealed to in respect to the question at issue. 

As we have seen, it is admitted that pneumonia is sometimes an 
idiopathic affection, caused, of course, in such cases, by atmospheric 
vicissitudes, or other kindred morbid influences, and unconnected 
with any complaint except ordinary phlegmasia. But, while admit- 
ting thus much, it is contended that, in the majority of instances, 
the disease must be referred to a different origin, and viewed as 
simply symptomatic ; that it is a mere form of another complaint, 
and would not, it may be presumed, exist if the causes of the latter, 
whatever they may be, did not exercise their baneful influence. It 
is suggested that the combination of phenomena, which impressed 
the common observer with the idea that he beheld a special and in- 
dependent complaint, was fallacious — really nothing more than a 
cloak, serving to disguise a disease which, in its natural state, 
assumes a different dress ; and that, while with infantile simplicity 
we fancied we had before us a disease of well-known pathological 
character, it turns out that we were dealing with one of a totally 
different kind, in which the affection of the lungs constituted an 
accidental and unessential element. 

All this may prove acceptable in certain quarters; it may be 
regarded as plausible by some, or even as well founded and per- 
fectly unanswerable. But, so far as I am concerned, I have no 
hesitation in stating, as the result of my personal observations, aided 
by extensive inquiry and close reflection, that pneumonia is not 
sometimes but ahvays an idiopathic disease, whether it occurs spo- 
radically or epidemically ; whether in the South, in the North, in 
the East, or in the West; whether in fever districts, or in fever 
seasons, or in places or at periods of the year free from periodical 
fevers ; and that it is due to causes perfectly distinct from those to 
which such fevers owe their origin. I believe this; and believe, 
besides, that even were pneumonia produced at times by the legiti- 
mate causes of fevers, such cases would not be any more symptomatic 
than those that are due to the ordinary causes of the disease ; for 
these do not act directly and primarily on the lungs any more than 
the others would do, supposing them capable of giving rise to the 
effect in question. And as in either circumstance the primary im- 
pression is received by some other part of the system, and thence 
reflected on the pulmonary organs, the two sorts of cases must be 
placed on the same footing, and be all primary or all secondary. Of 



56 PNEUMONIA AND 

course we must exclude from the cases thus referred to, those pro 
duced by traumatic or mechanical injuries, and agencies acting 
directly on the lungs, for these might, strictly speaking, be called 
symptomatic. It may, perhaps, also be proper to exclude some of 
those in which symptoms of pneumonia show themselves during the 
progress of other diseases, or after extensive surgical operations or 
wounds. I say in some, for while in these the inflammation of the 
lungs is secondary, and merely the effect of sympathetic irritations, 
which may and do arise in a variety of dissimilar complaints, and are 
somewhat influenced by the nature of the cause giving rise to them ; 
in others, the pneumonia may properly be called idiopathic, inas- 
much as it is independent for its causation of the agency giving rise 
to the prior complaint, being produced by the same causes which 
would have given rise to it had no such disease, operation, or wound 
preceded. But, whatever be the mode of origin of such cases, many 
of which properly belong to a category to which attention will be 
called by and by, it may safely be maintained that pneumonia, when- 
ever it shows itself ah initio, is idiopathic, that it is always produced 
by its appropriate causes, and, what is more to our present purpose, 
that it is independent for its origin of those morbid agencies to which 
autumnal fevers are due ; that it is not less independent of such 
fevers in a pathological point of view, and that it cannot, therefore, 
be lowered to the rank of a peculiar form of that class of diseases. 

1. Pneumonia common where fevers seldom or never are seen. — It is 
scarcely necessary to remark that inflammatory affections of the 
substance, and lining, and covering membranes of the lungs, prevail 
very extensively in places where remittent, intermittent, and other 
fevers of kindred nature are not observed, and during seasons of the 
year when, if the ordinary causes of fever had at any time exercised 
their influence, they have been effectually or temporarily checked. 
With us, pneumonia prevails, during certain periods of the year, in 
localities where autumnal fevers, especially intermittents, rarely if 
ever originate. In Philadelphia — and the same may be said of 
other large cities— such a thing as a case of the latter disease is 
seldom encountered. When the disease does present itself, it is 
usually seen among individuals who have taken it elsewhere. On 
the other hand, in our extreme suburbs and in the surrounding 
open country, where remittents and intermittents are sometimes 
quite rife, and always, except in winter, more or less noticed, pneu- 



AUTUMNAL FEVEES. 57 

mo n.ia is not much more common than we find it to be in the city 
proper; not more so, at least, than can be accounted for by the 
greater exposure of the inhabitants to atmospheric vicissitudes and 
other known causes of the disease. Within the limits of the bills 
of mortality, including the city proper, where periodic fevers are 
scarcely ever seen, and a few only of the fever districts, the propor- 
tion of deaths from inflammation of the lungs and bronchias, in 
thirteen years, 1836-184:8, amounted to 1 in 11.7. 1 Again, in the 
cities of our Middle States, the yellow fever, which, as we have 
seen, approximates to, without however being identical with, ordi- 
nary autumnal fevers, shows itself only in certain confined and 
peculiarly circumstanced localities, especially along and near the 
wharves. Now if there are facts to show that pneumonia is more 
common in such localities, during sickly seasons or at any other 
time, than in other places where the fever never reaches, unless 
imported, an experience of upwards of thirty years has not enabled 
me to discover them, and I am sure no one has been more fortunate 
than myself on that score. Most American medical readers know, 
or if they do not, a perusal, among others, of Dr. Holmes's excel- 
lent Dissertation on Intermittent Fevers will teach them, that this 
disease is of rare occurrence in New England, except in certain 
circumscribed localities to be noticed by and by, and that it has 
disappeared in places where some years ago it prevailed more or less 
extensively. It may be remarked, also, that in other localities of this 
country, and in various cities and rural districts of France, England, 
Tuscany, Lucca, and other parts of Europe, to which I shall have 
occasion to call attention as I proceed, inter mittents, which before 
had spread extensively, have so effectually been chased away, by 
the judicious application of hygienic means, as to be now but rarely 
encountered. But while such has been the case with regard to 
malarial fevers, we are perfectly safe in affirming that pneumonias 
have not disappeared together with the former from any of those 
spots of New England, which have so much improved in point of 
salubrity ; that the disease prevails over the whole region now as it 
did formerly, and that hence there are few physicians better ac- 
quainted with its phenomena than our brethren of the Eastern 
States. Among our troops in the military posts on the coast of 
New England, the ratio treated per thousand of mean strength, 

1 Trans, of Coll. of Phys. ii. 375. 



58 PNEUMONIA AND 

amounts, according to Forry, to 41. 1 On a mean strength of 3,138, 
there were 233 cases of catarrh and influenza, 22 of pneumonia, and 
26 of pleurisy. 2 

Nor is it less certain that the same remarks are applicable to 
the localities in Europe above referred to ; for there pneumonias 
continue to prevail as extensively and fatally as when their insa- 
lubrity from malarious influences was most noted. Take Paris 
and London as examples. According to Dr. Lombard, pneumonia 
constitutes, in the former, one-fourteenth part of the diseases of 
adult subjects, while in children the proportion varies from one- 
fourth to one-fifth. 3 The correctness of this estimate is confirmed, 
so far as regards adults, by the results obtained by Grisolle, who, on 
comparing, during three years, the frequency of that disease, rela- 
tively to that of all other internal complaints, in the hospitals of that 
eity, found that the former constituted the fourteenth, fifteenth, or 
seventeenth part of acute and chronic complaints. In asylums for old 
people, the average proportion of pneumonias appears to vary from 
one-sixth to one-seventh. 4 To this it may be added, as corroborative 
of the extreme frequency of pneumonia in Paris, that the average 
mortality in the ten years, 1837-1848, from pulmonary catarrh, 
amounted to 2,222, and that from pneumonia to 2,637. 5 I am aware 
that a contrary statement has been made in regard to London and 
other parts of England. Dr. Wells, as we have seen, insists on the 
decrease of thoracic inflammation in that city since the diminished 
prevalence of malarial fevers, and appeals to other physicians for 
the occurrence of a similar result elsewhere. A Mr. Weeks, of 
Sussex, informed him that genuine pleurisies were not seen there 
now as formerly. Dr. Wells farther refers to Dr. Harrison, of Horn- 
castle, who mentions incidentally, in different parts of An Essay on 
the Rot in Sheep, that both agues and acute inflammation of the 
lungs are less common in Leicestershire than they used to be. "Ac- 
cording to Sydenham," Dr. Wells continues, " no disease was in his 
time more frequent than pleurisy. At present, a physician in con- 
siderable practice here may pass several years without seeing a 
single legitimate instance of it." Dr. Wells, it is true, finds that Dr. 
Willan, in his Report on the Diseases in London, from 1796 to 1800, 
makes frequent mention of thoracic inflammations ; but he believes 

1 Forry ; Climate of U. S. 238. 2 j bid 2 42. 

3 Archives Gen. de Me"decine, xxv. 68. 4 Traite" de la Pneumonie, 127. 

6 Trebuchct; Ann. d'Hygiene, xlvi. 20. 



AUTUMNAL FEVERS. 59 

that that eminent physician must have called diseases by the name 
of pleurisy which differed considerably, in regard to the mode of 
treatment they required, from the same complaint referred to by 
Sydenham ; and closes with the remark that the instances of acute 
inflammation of the contents of the chest which fell under his ob- 
servation, in London, were almost solely peripneumonias, in which 
copious bleeding was less clearly indicated, and was attended with 
less benefit than commonly happens in pleurisies ; and one-half, per- 
haps, of these instances, which were not numerous, supervened to 
acute rheumatism. 1 

Without stopping to examine how far the reasons assigned by Dr. 
Wells for doubting the frequency of thoracic inflammation in London 
are correct, and without denying the possibility of the decrease of 
pleurisy in Sussex or Horncastle, I may remark that the statements 
of eminent writers and statisticians do not bear that physician out 
in his conclusions. According to Dr. Farr, who has devoted much 
attention to the subject, 2 while in all England the mortality from 
pneumonia amounted in 1838 to about one twenty -fifth part of the 
whole number of deaths, and to about one-twentieth of those from in- 
ternal diseases, in London the proportion amounted to about one- 
fifteenth of the whole deaths, and one-thirteenth of those from 
internal complaints. In London, the average deaths from 1820 to 
1831, inclusive, occasioned by inflammation of the lungs and pleu- 
risy, amounted to 2,0 77. 3 In 1839, while the deaths from those dis- 
eases in England and Wales amounted to one in 18.01 of the mor- 
tality from all causes excepting external violence, the loss in London 
was one in one hundred and twenty-nine, being 3,687 from pneumo- 
nia, and sixty -five from pleurisy. In 1840, the proportion did not 
differ very materially from this. Sir Gilbert Blane states that, dur- 
ing ten years' service at St. Thomas's Hospital, he attended upwards 
of 320 cases of pulmonary inflammation, and 192 of intermittent 
fever. In private practice, during another period of ten years, 1795 
to 1806, he attended, out of 3,160 cases of various diseases, 145 of 
pulmonic inflammation, and only twenty-five of intermittent. 4 

Other facts lead to the same conclusions. If we turn to Nova 

1 Transactions of a Society for the Diffusion of Med.-Ch. Knowledge, iii. 539-541. 

2 W. Farr, First Annual Report of the Registrar-General of Births, Marriages, &c. 
London, 1839, p. 168. 

3 Marshall, Mortality of London, last table. 

4 Select Dissertations, i. 205-247. 



60 PNEUMONIA AND 

Scotia, Malta, Bermuda, and Gibraltar, and examine how matters 
stand there in relation to the question before us, we shall find 
that malarial fevers are rarely encountered, while both residents and 
visitors suffer extensively from pneumonia. In Gibraltar, Dr. Hen- 
nen 1 states that malarial fevers seldom show themselves, while the 
mortality from pulmonary inflammation is very large. 2 The tables 
furnished by Major Tullock, show that, in an aggregate strength of 
60,269, the admissions among the troops for quotidian, tertian, 
and remittent fevers, amounted in nineteen years, 1819-1836 (ex- 
clusive of cases occurring during the yellow fever epidemic of 1828), 
to 616, and for yellow fever to four. At the same time, the number of 
cases of inflammation of the lungs reached 2,515, and of pleurisy 
twenty-eight, or 2,543 ; giving an average of 42.3 per 1,000. 3 In 
Malta, with a strength of 40,826, the admissions for periodic fevers 
(intermittents and remittents) amounted to 695, or seventeen per 
1,000 ; those for inflammation of the lungs to 1,370 ; and for pleu- 
risy, to twenty-one — total, 1,391 ; or thirty per 1,000 ; 4 the mortality 
being one-fifteenth of the whole. 5 In Bermuda, in an aggregate 
strength of 11,721, those same fevers — intermittent and remittent — 
amounted to forty-six, and inflammation of the lungs and pleurisy 
to 441, or seventeen per 1,000. In Nova Scotia and New Bruns- 
wick, malarial fevers figure in the tables for 52, while inflammation 
of the lungs presents an aggregate of 1,505, to which must be 
added seventy-two cases of pleurisy, which, the strength being 
44,120, gives us a proportion of thirty-five per 1,000. It is proper 
to state that I have excluded, in this comparison, the common con- 

1 Topography of the Mediterranean, 490. 

2 Ibid. 498. 

3 Mortality of the British Army, pp. 7-11. 

4 At page 64, Major Tullock states that, from 1830 to 1836, the aggregate strength 
at Gibraltar being 22,868, 655 cases of pneumonia and pleurisy were admitted, or 
twenty-nine per 1,000. At Malta, the strength being 15,031, the cases amounted to 
456, or 30.3 per 1,000. At page 17, we have the following table, which exhibits at a 
glance those proportions in 19 years : — 

Aggregate strength 
Pneumonia. in 20 years. 

Gibraltar, 60,269 

Malta, 40,826 

Ionia Island, 70,293 

11,721 
44,120 



Bermuda, .... 

Nova Scotia and New Brunswick, 



lUUUSSJUU 

. and PI. 


Per 1,000 


2,543 


42 


1,391 


34 


2,272 


32 


441 


37 


1,577 


35 



s Mortality of the British Army, pp. 22, 23. 



AUTUMNAL FEVERS. 61 

tinued fever mentioned in the reports. Its origin from the malaria 
of common an tumnal fever is doubtful, and being found to prevail in 
the most diversified climates, it may be viewed as the typhoid fever 
of most modern writers. At Constantine, in Africa, palndal fevers 
are not common, and, according to Dr. Antonini, physician in chief 
of the French army of occnpation, when they appeared among the 
soldiers, they had most generally been taken elsewhere. Thoracic 
inflammations, on the contrary, are very frequently noticed 1 in that 
vicinity. Pneumonias are very common in Chili, at all seasons of 
the year, though more particularly during the spring months. On 
the other hand, intermittents and other forms of malarial fevers are 
there rarely encountered. 2 

The city of Turin, in Italy, is exempt from those fevers ; but 
pneumonia is of common occurrence. 3 Similar observations have 
been made at Genoa. 4 Sweden, except in some few of its southern 
and alluvial districts is, like several other northern countries, free 
from malarial fevers. But so frequently is pneumonia encountered 
there that, by Hoffman, it was viewed in the light of an endemic. 5 

2. Pneumonia not necessarily prevalent where fevers are common. — 
If now we reverse the proposition, and inquire into the frequency 
of pneumonia in malarious and fever localities — a frequency which 
we might reasonably expect to occur, were the causes of the dis- 
eases and their pathology the same — we shall find little reason 
to admit the correctness of the hypothesis under examination. 
Hippocrates, it is true, may be, and indeed has been, appealed to 
in support of the fact that pneumonia is of common occurrence 
in paludal countries; and there is no doubt that if his testimony 
can avail in the settlement of this matter, and be considered con- 
clusive, the advocates of the opinion in question may congratulate 
themselves, for the language of the Coan physician is explicit: 
"And I wish to give an account of the other kinds of waters, 
namely, of such as are wholesome, and such as are unwholesome, 
and what bad and what good effects may be derived from, water, 
for' water contributes much towards health. Such waters, then, 

1 Boudin, Georgia Med. 80. 

2 Lafargue; Bulletin de l'Academia de Meclecine, xvii. 178-203. 

3 Mem. de l'Acad. de Med. xiv. 230-1. 

4 Ann. d'Hyg. xxx. 58 ; xxxv. 5 ; xxxvi. 304. 

5 Williams ; Cyclop, of Pract. Med. iii. 408. 



62 PNEUMONIA AND 

as aTe marshy, stagnant, and belong to lakes, are necessarily hot 
in summer, thick, and have a strong smell, since they have no 
current ; but being constantly supplied by rain-water, and the sun 
heating them, they necessarily want their proper colour, are 
unwholesome, and form bile; in winter they become congealed, 
cold, and muddy with the snow and ice, so that they are most apt 
to engender phlegm and bring on hoarseness; those who drink 
them have large and obstructed spleens; their bellies are hard, 
emaciated, and hot ; and their shoulders, collar-bones, and faces are 
emaciated." " This disease is habitual to them both in summer and 
in winter; and, in addition, they are very subject to dropsies of a 
most fatal character; and, in summer, dysenteries, diarrhoeas, and 
protracted quartans frequently seize them ; and these diseases, when 
prolonged, dispose such constitutions to dropsies, and thus prove 
fatal. These are the diseases which attack them in summer ; but, 
in winter, younger persons are liable to pneumonic and maniacal 
affections ; and older persons to ardent fevers from hardness of the 
belly." 1 

In our days, the statement has received the sanction of no less an 
authority than the great Joseph Frank, from whom we learn that, 
in the course of an extensive practice, he never saw so large a num- 
ber and so great a variety of pneumonias as among the peasant 
inhabitants of the rice fields of the canton of Tessino, where paludal 
fevers are endemic. 2 But facts in abundance may be collected to 
show that though under some circumstances pneumonia may pre- 
vail frequently, or even extensively, in localities subject to malarial 
fevers — as the environs of Strasburg, Pavia, Padua, Eome, Naples, 
the vicinity of Vesuvius, as well as in many parts of this country will 
attest — it frequently happens that in such localities, even where 
the paludal cause exercises its baneful effects with great energy, 
inflammation of the lungs is comparatively rare, and in some 
scarcely encountered. Indeed, there are not wanting reasons to 
justify the opinion that, on the point in question, the father of medi- 
cine must be regarded as an unsafe guide, and that his statement 
should be received with great caution. For, though in the marshy 
districts of Greece, inflammatory affections of the lungs may, for 
what we know, have been frequently seen by him — a fact which, 
as we shall see, recent observations do not tend to confirm — the 

1 Adams's transl. i. 195-6 ; Airs, Waters, and Places ; Littre's trans, ii. 29. 

2 L'raxco's Med. ii. pt. ii. 315. 



AUTUMNAL FEVEKS. 63 

cases so noticed were, probably, in most instances, nothing more 
than severe catarrhal affections. In saying this, I trust I shall not 
be considered as undervaluing the merits of this truly extraordi- 
nary man ; but, whatever may have been the remarkable powers of 
observation he possessed, it is not to be supposed that his diagno- 
stical proficiency was such as to enable him invariably to discri- 
minate with accuracy between catarrh and true parenchymatous 
inflammation of the lungs. 

Dr. Forry, in his account of the climate of the United States, 
remarks of pneumonia, pleurisy, and catarrh, that they are " inva- 
riably less prevalent in the moist and changeable climate peculiar to 
the sea-coast and large lakes, than in the dry atmosphere of the 
opposite locality;" 1 and we all know that it is precisely in the 
former localities that fever abounds. In the northern division, the 
average number of cases of pneumonia in 1,000 was found to be 
45 ; that of intermittent and remittent fevers, 231. In the middle 
division, the averages in 1,000 were 74.5 of pneumonia, and 739 of 
fevers ; and, in the southern division, the average of pneumonia in 
1,000 was 43, and of fever 598. 2 

In the East Indies, where jungle and remittent fevers are com- 
mon, pneumonia is scarcely known. Desportes, while quoting the 
old aphorism, callidum pedori amicum, frigidum inimicum, informs 
us that the disease is less frequent in St. Domingo, one of the 
most malarial of the "West India Islands, than in France. 3 

In the Windward and Leeward islands, as well as in Jamaica, where 
sources of malaria abound, and where fevers, in consequence, con- 
stitute near one-half of the prevailing diseases, pneumonia, so far 
from being a common complaint, is rarely encountered. In the 
former command, an average military strength of 4,333, gave, in 
twenty years, 1817-37, 62,163. Of these, 24,607 were quotidians; 
1,973 tertians; 133 quartans; 17,799 remittents, and 774 yellow 
fever. This makes a total of 45,286 malarial fevers, the balance 
being common continued (typhoid ?), typhus, and synochus. During 
the same period, inflammation of the lungs furnished a quota of 
only 1,941, and pleurisy of 34. 4 In the Jamaica command, with 
an average military strength of 2,578, the number of fever cases 
were no less than 46,922, or 910 per 1,000. Of these cases, not 

1 Climate of the United States, 359. 2 Ibid. 233, 277, 284. 

3 Maladies de St. Domingue, i. 32. 

4 Tullock, Med. Statistics of Brit. Army, 7, 8. 



64 PNEUMONIA A1SD 

less than 6,090 were intermittents, or 38,393 remittents, and 20 yel- 
low fever ; the total being 44,503 autumnal or periodic cases. 1 Br. 
Eufz, in a communication made to Dr. Grisolle, 2 states, as the result 
of his personal observation, that pneumonia is very uncommon at 
Martinique. 

"Although we encounter in Senegal," says Thevenot, "the greater 
number of the pathological changes incident to temperate climates, 
and although endemic diseases there differ in nothing but fre- 
quency and severity from our own, yet there are some which will 
command almost exclusively our attention, because they prevail 
much more frequently than all others. Eemittent and intermittent 
fevers, dysentery, hepatitis and nervous colic constitute the most 
dangerous enemies of Europeans. At the same time inflammation 
of the thoracic organs, though not unknown, is rare, and in a list of 
952 cases of disease, treated from July, 1837, to July, 1838, mala- 
rial fevers amounted to 509, while pleurisies and pleuro-pneumo- 
nias did not reach above 5." 3 At Bone, in Africa, as we learn 
from Dr. Maillot, pneumonia is an excessively rare disease ; while 
malarial fevers, on the contrary, abound to an unprecedented de- 
gree. Of 3,765 cases of disease treated by him from 9th Febru- 
ary, 1834, to 15th March, 1835, only 6 were affected with pleuro- 
pneumonia. 4 In Upper Canada, where malarial exhalations, and, as 
a consequence, autumnal and periodic fevers abound much more 
than in the lower section of that country, pneumonia prevails much 
less extensively. The proportion of the latter disease in Upper 
Canada, per 1,000, is noted by Major Tullock at 60; in Lower Ca- 
nada at 30 ; while the proportion of intermittent fevers per 1,000 
in the former was 178, and of remittent 12; and the proportion of 
intermittents in the latter was only 26 per 1,000, and of remit- 
tents l. 5 In French Guiana, and especially at Cayenne, where 
malarial fevers are proverbially common, and the climate is justly 
considered in consequence as excessively insalubrious, thoracic in- 
flammations are rarely encountered. 6 It is true that Campet tells 
us a very different story on the subject. But he admits that such 

1 Tullock, Med. Statistics of Brit. Army, 46, 47. 

2 Traits de la Pneumonic, 132. 

3 Tr. des Maladies des Europeens, dans les pays Chauds, 232, 240. 

4 Traits des Fievres Intermittentes, 114. 

5 Opera tit. 27, B ; 29, B. 

6 S6gond Apercu sur le Climat et les Maladies de Cayenne, 1831, quoted by Gri- 
solle, 133. 



AUTUMNAL FEVEKS. 65 

inflammations are principally rife among the slaves who do field 
work, are destitute of proper clothing, and sleep on planks in 
badly constructed huts, where, unless protected by large fires, they 
are apt to suffer during the low temperature of the night and break 
of day. 1 

Similar are the results obtained on the western coast of Africa, 
almost every point of which may be regarded as a hotbed of mala- 
rial fevers. From Major Tullock, we learn that the Sierra Leone 
command presented, in a total number of 5,489 cases of disease, 
2,600 of fever. Of these, 948 were of intermittents, and 1,601 of 
remittents, which, with 51 of common continued, were in the pro- 
portion of 1,411 per 1,000 of mean strength. In the list, the affec- 
tions of the lungs figured for 103, being in the proportion of 56 per 
1,000; and pneumonia for 15, or 8 per 1,000. 2 In conclusion, I 
may here mention a fact, to which Grisolle has already called atten- 
tion, that Monfalcon, in his treatise on marshes, though pointing out 
the frequency of pulmonary catarrh in paludal localities, nowhere 
enumerates pneumonia among the diseases peculiar to them ; 3 and 
that ISTepple, though asserting the fact in positive terms, disproves his 
own statement by showing, that in a total of 1,352 cases of disease, 
admitted into the wards of the Hospital of Montluel (Ain) during 
the course of four years, intermittent and remittent fevers furnished 
not less than three-sevenths of the whole, while pneumonia came in 
for only one-sixteenth. 4 In the Ionian Islands, with an aggregate 
military strength of 70,293, the cases of malarial fevers in twenty 
years, 1817-1836, amounted to 16,252, being in the proportion of 
230.5 per 1,000, while the cases of pneumonia and pleurisy amounted 
to 2,272, or 31.2 per 1,000. 5 

Again, in some parts of the south of Spain, where acute inflam- 
mation of the lungs is rarely encountered, paludal fevers, on the 
contrary, are very prevalent, and constitute, with gastro-enteritic 
and hepatic inflammation, the great bulk of the diseases of the 
country. 6 Dr. Eoux calls attention to the fact of the small propor- 
tion of thoracic affections, acute and chronic, in the Morea, where 
paludal localities extend far and wide, and where malarial fevers 
are necessarily abundant. " In France," he remarks, " at this season 

1 Maladies desPays Chands, 210, 211. 

2 Mortality of the British Army, 8-10. 3 Ibid. 500. 

4 Nepple, Essai sur les F. Int. et Remit. 15, 297. 5 Tullock, 32, 34, 35. 

6 Boudin, Geog. Med. 85. 

5 



66 PNEUMONIA AND 

of the year (January), if we were to collect an equal number of sick 
in a hospital ward, we should hear little else than the sound of 
cough, and many convalescents would present, at the moment of 
their discharge, the sequelae of some thoracic affection. Here, no- 
thing of the kind occurs." 1 Few countries suffer more from mala- 
rial fevers, intermittents and remittents, than the Island of Ceylon. 2 
Statistical returns of the diseases observed there among Europeans, 
show that pneumonia forms but a small item in the list, the number 
of cases being only 615th of that of all diseases, acute and chronic. 3 
Dr. Davy also states that diseases of the lungs are exceedingly un- 
common in that island, both among Europeans and natives. Asthma 
and pneumonia now and then occur (p. 491). According to Dr. 
Marshall, the proportion of deaths among the troops from all dis- 
eases and from pneumonia, from 1816 to 1820, inclusive, was as 
follows : — 

From all diseases. From pneumonia. 

1816 63 2 

1817 57 7 

1818 513 6 

1819 310 6 

1820 139 8 

This gives us a total of 1,082 from all diseases, and of 29 from 
pneumonia, or 1 in 37.27. 

During a period of three years, extending from 21st of December 
to 20th of the same month, 1817-1818, 1818-1819, and 1819-1820, 
the number of cases among European troops treated in the hospi- 
tals of Badula and Kandy, were as follows : — 

First Period. Badula. Kandy. 

Fever, intermittent, .... 224 746 

" remittent 163 337 

" common continued . 000 104 

Pneumonia 4 16 

Second Period. 

Fever, intermittent .... 86 170 

" remittent 94 83 

" common continued . . 00 84 

Pneumonia 2 00 

1 Hist. M6d. de l'Armee Francaise en Moree, 84. 

2 Davy : An Account of the Interior of Ceylon, 4to. 493. Marshall, Notes on the 
Med. Top. of Ceylon, 39. 3 Grisolle, 130. 



AUTUMNAL FEVERS. 67 

Third Period. Badula. Kandy. 

Fever, intermittent .... 20 11 

" remittent 13 3 

" common continned . . 00 108 

Pneumonia 1 14 

"We have here, in three years, a total of 2,246 cases of endemic 
fevers of various types ; while pneumonia figures in the list for 37, 
or 1 in about 61. 

It is to be remarked that the few cases of pneumonia observed, 
occur principally, if not exclusively, among the Malay, Indian, and 
Caffre tribes; the Europeans, who are most liable to endemic fevers, 
being comparatively but little liable to the disease. 1 

But these facts must suffice. So far as they go, they seem con- 
clusive ; and with suitable deference to the authority of writers who 
entertain sentiments different from those which it is my object to 
uphold, I cannot think I hazard much when expressing the opinion 
that the impartial reader, after perusing what precedes, will acknow- 
ledge that it will puzzle them, talented and ingenious as some of 
them undoubtedly are, to reconcile those facts with the hypothesis 
set forth regarding the identity of pneumonia with malarial fevers. 
Let them, if possible, account for the aforesaid circumstances — the 
absence of malarial fever where pneumonia is rife ; and the exten- 
sive prevalence of the former in localities where the latter is either 
not of remarkable frequency, or scarcely seen at all — the cessation 
of the one and continuance of the other — and say how all this could 
be brought about, if the inflammation of the lungs, in the disease in 
question, were due to the agency of the cause producing those 
fevers ; in other words, if pneumonia were really and substantially 
nothing more than a peculiar form of remittent and intermittent 
fever. Were the etiological connection and pathological dependence 
such as maintained, we should expect to find that the cause, if dif- 
fused in such localities to an extent, and possessed of a degree of 
energy, sufficient to produce a large number of cases of pneumonia, 
or, as others would say, of the pneumonic form of autumnal fever, 
would also give rise to a greater or less number of cases of the other 
and more legitimate and characteristic forms of those fevers. This 
would be the more natural to anticipate, because the climatorial 
influences noted in those favored spots where fevers have never 

1 Notes on the Med. Topog. of the Interior of Ceylon, 92-129. 



68 PNEUMONIA AND 

prevailed, or have long ceased to do so, are not different from those 
under the empire of which such fevers everywhere appear ; or have 
remained the same amid all the changes that have occurred in 
regard to their prevalence ;— the only difference consisting in 
the absence or removal of certain terrestrial or local conditions, 
which, whatever be the nature of their association with the ordinary 
forms of the supposed protean disease, have apparently nothing in 
the world to do with the existence of what is now maintained to be 
simply another form of the same. The result being different — 
pneumonia occurring where autumnal fever has never originated, 
or where, if it has done so, it now seldom if ever prevails — we are 
warranted in concluding that the causes of the two diseases are 
different ; that the one may exist without the other ; that when the 
two diseases show themselves at the same time, and in the same 
locality, two sets of causes necessarily exercise their baneful in- 
fluences and produce, not one disease assuming different forms, and 
presenting different aspects, but two distinct complaints; and that, 
consequently, pneumonia cannot justly be held up as forming part 
and parcel of autumnal fevers, which, as regards etiology, are 
governed by very different laws, and influenced by very different 
agencies. 

3. The two diseases prevail in different seasons. — The contrast 
between the two diseases is particularly striking as regards 
the seasons in which they mostly prevail. As the name usually 
affixed to malarial fevers indicates, the latter is, in our latitudes 
especially, a disease of autumn. It seldom appears before the 
middle or close of summer, and ceases on the accession of win- 
ter. Its existence in an epidemic form in temperate regions, is 
never known to occur in the spring of the year ; — cases that occur 
in that season, or in winter, being accounted for without having 
recourse to the supposition of the development then of the efficient 
cause. It never shows itself in winter, and if it appear early in 
summer — which is seldom the case — the occurrence is only noticed 
under peculiar circumstances of atmosphere existing during the 
preceding months, and which invest these with the characteristic con- 
ditions appertaining to autumn. It is emphatically a disease of hot 
weather, requiring for its production a continuance for some time 
previous of high atmospheric heat. It appears, generally, some weeks 
after the hottest month; the period being retarded as we proceed 



AUTUMNAL FEVERS. 69 

north. For the same reasons it may readily be "understood to be a 
disease of hot latitudes, prevailing, as it does, violently and almost 
perpetually within the tropics, and ceasing long before we reach 
the polar circle. Dr. Drake, who has noted all these circumstances, 
has, from extensive observations, arrived at the conclusion that, 
with the decrease of yearly and summer heat, other conditions re- 
maining unchanged, there is an abatement of fever. Taking the 
heat of summer alone into consideration, he thinks we may assume 
that a summer temperature of sixty degrees is necessary to the 
production of fever ; that it will not prevail as an epidemic where 
the temperature of that season falls below sixty-five degrees ; and 
that, if the other conditions favouring its production are deficient, 
it will cease before those reductions of temperature have been 
reached. 1 

In the Mediterranean stations, the admissions into the hospital, 
and the deaths, average nearly twice as high between July and 
October as during any similar number of months in the year. 2 In 
Spain and Portugal, the sickly season, in malarial districts, is from 
July to September. 3 The fever of Eome, in general, is held to 
begin with the great heats about the end of June. The Koman 
people have fixed on St. Peter's day as the exact period of its out- 
break, and it reigns from then till it is put a stop to by the equi- 
noctial or autumnal rains of September. The readers of Horace 
will recollect that, in his time, July was notorious for its insalu- 
brity. " Adducit febres et testamenta resignat." 

In this country and in Canada it commences in July or August, 
and ends, in the south in November or December, and in the north 
about October. In England, much the same results are obtained. 4 

In hot latitudes, where the heat is almost constant, the fever, if 
not constant also, commences earlier than in our latitudes, and lasts 
later when not put a stop to by unusual agencies. On the African 
coast it exists to some extent at all seasons ; but is formidable from 
April to November, and especially rife from July to the last-men- 
tioned month. In Senegal, thundershowers commence towards the 
close of April, or beginning of May, and continue to the middle of 
July, when the rains set in. This season (hivemage) lasts to the end 

1 A Systematic Treatise on the Principal Diseases of the Interior Valley of North 
America, 712. 

2 Williams, on Morbid Poisons, ii. 460. 3 Macgregor, Med.-Chir. Tr. vi. 387. 
4 Williams, op. cit. Watson, 445. 



70 PNEUMONIA AND 

of October or beginning of November. It is at this period (the 
hottest of the year) that remittent fevers usually make their appear- 
ance. 1 In the West Indies, also, the period of the greatest liability 
is between July and December, when the hottest weather, com- 
bined with considerable moisture, prevails. In Bengal, fever com- 
mences in August, and continues till November. 2 In Ceylon, the 
months of June, July, and August are, in general, the period of 
the year when the greatest sickness prevails. 3 In a word, the 
epoch of appearance and disappearance may vary in different 
localities according to the situation of these, and their position 
relative to the equator, and the consequent modification in the 
period of the seasons ; but everywhere endemic or autumnal fevers 
break out, or are most rife, during or shortly after the hottest 
weather. 

So far as regards the yellow fever, the disease may still more 
appropriately be denominated one of hot weather ; requiring, as it 
does, a higher average temperature during the summer months — 
not less than between 76 and 80 degrees (Fahr.). It manifests itself 
in no climate where the temperature is below that average, and 
ceases to appear long before we reach the limits assigned to ordi- 
nary periodic fevers. In our climate it has commenced as early as 
June. Such was the case in this city in 1799, and in Charleston in 
1837. We even find that in the year 1732 it appeared in the latter 
city as early as May. In 1852, one death by yellow fever was re- 
ported in May, and another in June. In 1819, the disease broke 
out in this city about the end of June. Such was the case in New 
Orleans in 1848. But instances of this kind are rare, and when 
they occur, the progress is at first slow, and the disease presents 
more the character of a sporadic than of an epidemic visitation. 
More frequently, the fever breaks out about the middle or end of 
July, often in August, and sometimes as late as September. Thus 
it began its epidemic career in the course of July, in Philadelphia, 
in 1747, 1794, 1797, 1802, 1803, 1805, and 1820; in Norfolk, in 
1800, and 1821 ; in Providence (K. I.), in 1805 ; at Brooklyn (N. Y.), 
in 1809 ; in New York, in 1799, and 1803 ; at Woodville^Miss.), in 
1845 ; in New Orleans, in 1817, 1844, 1847, and 1853 ; Eodney, in 
1847 ; Boston, 1798, and 1819. Our epidemics of 1699, 1762, 1793, 

1 Levacher, 48. 2 Clark on Long y oyageSj 1 n6. 

3 Marshall, Topography and Diseases of Ceylon, 39. 



AUTUMNAL FEVEKS. 71 

1798, commenced in August, as did also those of Charleston, in 1782, 
1739, 1745, 1748, 1849, 1852; of Baltimore, in 1798; of New 
York, in 1791, 1797; of Providence, in 1798, and 1800; of New 
London, in 1798 ; of Boston, in 1819 ; of Wilmington (Del.), in 
1798, and 1800 ; of Natchez, in 1817, 1819, 1823, and 1825 ; of New 
Orleans, in 1819 ; of St. Augustine, in 1839 : of Mobile, in 1819, 1843, 
and 1847 ; and of Vicksburg, in 1847. In Gibraltar, Leghorn, and 
the various cities of Spain where the fever has prevailed — as Medina, 
Sidonia, Malaga, Antiquar, Cadiz, Barcelona, Xeres, &c, the period 
of appearance has varied from July to September ; never earlier nor 
later. But in Europe, as in this country, at whatever time the dis- 
ease may break out, it ceases as an epidemic, or even altogether in 
October, November, or December. 

In the West Indies, and on the African coast, it makes its ap- 
pearance, as might easily have been foreseen from the greater pre- 
cocity of the hot season, at an earlier period than it usually does 
in this country and in Europe ; while in some years, owing to the 
greater encroachment of hot weather on the autumnal months, it 
breaks out later than it does in temperate latitudes — the period 
varying from April (or even earlier, as was the case at Granada, in 
1793, when it showed itself in February) to the middle or close of 
September. 

If we now turn to pneumonia, we shall find that the period of its 
prevalence is very different from that of the disease just referred to. 
Hippocrates, some three thousand years ago, and Areteus after him, 
pointed out the winter as the season in which the disease manifests 
itself most commonly, and subsequent writers have generally united 
in that sentiment. Sydenham, it is true, and after him the learned 
commentator of Boerhaave, affirmed, as the result of their observa- 
tions, that the disease attains its maximum between spring and 
summer. But the statement has not always been confirmed by 
subsequent authorities in this country and Europe. According to 
Chomel, pneumonia is more particularly rife in winter, spring, and 
the commencement of summer, and is rarely seen at the close of 
the latter season and during the autumn. Of 97 cases observed by 
that writer and Louis, at the Charity Hospital of Paris, 81 occurred 
between February and August, and 16 only during the other 
months. 1 Of 357 cases recorded by Leroux, and cited by Grisolle, 

1 Diet, de MeU xvii. 210, 1st ed. 



72 



PNEUMONIA AND 



116 occurred in winter, 137 in spring, 58 in summer, and 44 in 
autumn. Andral states that the disease prevails mainly in the spring 
months — March, April, and May. 1 The following are the results 
obtained by Grisolle in an examination of 296 cases: — 



January 20 

February .... 40 
March ..... 47 

April 62 

May .40 

June 8 



July . . 
August . 
September 
October . 
November 
December 



13 
3 

5 

2 
22 
34 



Admitting this to be a fair representation of the comparative 
monthly frequency of the disease among adults in Paris, it follows 
that pneumonia attains its maximum in April. Next come in order 
of frequency, March, February, and May ; then December, Novem- 
ber, and January ; while August and October present the smallest 
number of cases. 2 Hourman and Dechambre, cited by Grisolle, who 
investigated the subject among the aged inmates of the Salpetriere, 
found the cases more numerous in March. 3 At Geneva, on the con- 
trary, the disease often attains its maximum in May ; 4 while among 
children, Eilliet and Barthez point out February as the month of 
greatest frequency — a result modified, doubtless, as Grisolle re- 
marks, by the circumstance that the influenza was then existing in 
Paris. Facts very similar to those stated are recorded as being 
usually observed in England, in the more northern and southern 
districts of Europe, at Malta, in Bermuda, Nova Scotia, Canada, 
and in every part of this country and South America. 5 Every- 
where, among adults, children, and old people, idiopathic or primi- 
tive pneumonia appears to attain the maximum of frequency at 
the close of winter and in the spring, especially during the months 
of March and April. Next in point of frequency is the winter ; 
while the disease, though not unknown in summer, is comparatively 



1 Med. Clinique, i. 513. 2 Grisolle, 137. 

3 Op. cit. and Archives, xii. 2d series. 30. 

4 Essai Statistique sur la Mortality du Canton de Geneve, Ann. d'Hyg. xxiii. 51. 

5 Williams, Cycl. of Pract. Med. iii. 407; J. Frank, 311; Andral, i. 513; Tullock, 
44, B ; Wilson Philip, Tr. on Symptom. Fever, 204; Briquet, Arch. Gen. vii. 3d s. 482; 
llam.say, Charleston Journ. vi. 1, 2; Bell and Stokes, ii. 207; Smith on Epid. 
80 ; Johnson and Harris, Trans. Am. Med. Assoc, v. 373 ; Gerhard, Araer. Journ. 
1834; Ed. F. Williams, Stethosoope, ii. 544; Lafargue, Bulletin de l'Acad. xvii. 198 



AUTUMNAL FEVEKS. 73 

of rare occurrence during that season, and perhaps still more so 
during the autumnal months. 

Grisolle mentions farther, that of thirteen epidemics of pneu- 
monia, the authenticity of which cannot be contested, seven com- 
menced in spring, four in winter, one in autumn, and one in 
summer. 1 The epidemics noticed in this country have usually 
commenced in winter, and prevailed in that season and spring, the 
latter often furnishing the greatest number of the cases. 

4. They appear under the influence of opposite winds. — It is not to 
be forgotten that the two diseases do not usually manifest them- 
selves xmder the influence of the same order of winds. So far as 
regards malarial fevers, not a little in this matter will depend on 
the nature of the surface over which the wind may happen to pass 
before reaching the locality where the disease prevails; for at the 
proper period of the year, other things being favourable, fever 
will appear, as we shall see, in connection with any currents which 
waft the air from neighbouring surfaces where the elaboration of 
the morbific cause is going on. Edinburgh is supposed to derive 
fever through the agency of the east wind, which blows it from 
Holland. The same wind wafts malaria from Essex to London. 
The north-east wind blows malarial fever into some portions of 
Eome. Generally speaking, the western coast of Italy contains a 
more extensive elaborating surface than the eastern, in consequence 
of which, other circumstances being equal, the western currents are 
more prolific of fever than their antagonists. The same thing, and 
for the same reason, occurs in Europe generally, from the fron- 
tiers of Asia to the other extremity of that continent. In Batavia, 
the north-east wind, which is very prevalent during July, August, 
and September, is highly unfavourable to health. 2 So are the north 
winds at New Orleans during summer, 3 and the east and west winds 
at the Havana. 4 In Normandy, at Berniere, an unusual course 
of south-west winds blowing across a pestiferous region, and con- 
spiring with a hot summer, caused several violent epidemics. 5 In 
London, the south-east winds are apparently unfavourable for the 
same reason. 6 The same thing occurs in Dutch Guiana. 

1 Op. cit. 139. 2 Horsefield, Med. Mus. i. 79. 

3 Report on Fever of 1819, p. 50; Chabert, viii. pp. 9, 26. 

4 Osgood, 29. 5 Maccullocli on Malaria, 351. 
6 Second Report of Lond. Commissioners, 40. 



7-i PNEUMONIA AND 

"Yellow fever," says Dr. Bone, "prevails on Brimstone Hill, St. 
Kitts, when the strong north winds that have swept foul ground on 
Mount Misere impinge upon the persons in the ill-constructed bar- 
racks and out-buildings on that hill. And in Tobago, Dominica, 
Grenada, St. Vincents, and in all the hilly uncleared islands of the 
West Indies, strong north and east winds and rain, impinging upon 
the troops and their families in ill-constructed barracks, are causes 
of the disease." 1 "In St. Domingo," says Desportes, "the acclimated 
inhabitants regard the north wind as unwholesome, while the south 
wind is very pernicious to new-comers. This is particularly noted 
in the plain of the Cape, because the north-east and north-north-east 
winds, before reaching it, pass over a large surface of marshy locali- 
ties, from the effect of the exhalations of which the natives, who are 
proof against seasoning fevers, are not exempt." 2 

In this city and country, instances of the kind might be cited in 
abundance; but they, as well as many others, will find a more 
appropriate place in another part of the present volume. 

But however true it may be, that particular currents of winds 
exercise a baneful influence in the way mentioned, it is not less a 
fact which experience will everywhere confirm, that the existence 
of malarial fevers has almost invariably been connected, in tem- 
perate regions particularly, with the prevalence, during a greater or 
shorter space of time, of southerly currents, and that the influence 
that these exercise is not necessarily, and in some forms of the 
disease is very seldom, dependent on the malarial nature of the 
localities over which they happen to pass. Nor could this well be 
otherwise ; for these fevers require for their development the long 
continuance of a range of thermometrical heat, which could seldom 
be obtained during the prevalence of opposite currents. Under the 
influence of these winds, whether from due south, or from the 
neighboring points, S. E., E. S. E., or S. W., accompanied, as they 
are, with heat, and in many, if not most malarious regions, with hu- 
midity, fever originates and spreads to a greater or less extent; 
while from a change of these to other winds blowing from the 
opposite points of the compass, as 1ST., N. W., or K. E., there results 
a beneficial change in the healthfulness of the infected locality ; — 
a diminished prevalence, or even a cessation of the fever. In 
tropical climates, where the most frequent variations are from 

1 Essay, 15. 2 Maladies de St. Doniingue, vol. i. 21. 



AUTUMNAL FEVERS. 75 

E. S. E. to E. N. E., and where the wind never remains long at N. 
E. or S. E., and rarely blows from due north or due south, the pre- 
vailing current is always attended with considerable heat and moist- 
ure ; and with few exceptions, when the wind blows from the west 
longer than usual, and when the heat is nevertheless very great, 
as at Martinique in 1839, 1 the prevalence of fever is very usually 
associated with south-east or easterly currents. 2 One of the writers 
to whom I have referred below, and whose ample experience and 
great accuracy of observation cannot be doubted, remarks on the 
subject : "The development of the yellow fever in the West Indies, 
in a great number of men at the same time, in different parts, at 
a distance from each other, on a level with the sea, or slightly above, 
on board vessels in port or at sea, coincides so exactly with the in- 
crease of heat and humidity, and with the prevalence of the south 
winds, that it is impossible not to recognize in these meteorological 
conditions the true cause of the epidemics of yellow fever. The 
effect here is intimately and necessarily connected with its cause. 
The production and extension of yellow fever under the prolonged 
influence of the south winds, is a fact observed by every one ; so in- 
evitable, indeed, that it can be predicted without fear of ever being 
mistaken. This action of the south winds is felt here by everything 
that breathes. They produce undefinable effects on our senses. 
We feel them in bed, or sitting at the desk ; they enervate, cause 
oppression, and depress the spirits. To say in what these atmo- 
spherical alterations, the effects of which are so much to be dreaded, 
consist, and to seek to determine their specific nature, is doubtless 
a task beyond the faculty of man." "It is a fact, I cannot say it too 
often, that yellow fever is never developed in the same manner as 
other epidemics, but by and under the influence of the south winds. 
When this general cause fails, the yellow fever only exists in cer- 
tain restricted places, or only a few sporadic cases appear here and 
there, as occurred in 1819 and 1820. There were only, in all, forty- 
two men attacked by the yellow fever in the Hospital of Fort 
Eoyal in 1820, and yet, notwithstanding, the garrison, including sol- 

1 Rufz, 29, 54. 

2 Desportes, 19; Lempriere, i. 17; Bally, 361; Gilbert, 12; Humboldt, 765; Ro- 
choux, 113; Lefort, Du Quinquina et de la Saignee, &c. p. 66; lb. Mem. sur la non 
Cont. de la F.J. 9 ; Leblond, 81 ; Lind on Seamen, 67 ; Dariste, 33 ; Arnold, 26 ; 
Savaresi, 189, 242-3; Moreau de St. Mery, 716; Chisliolm, 88; Chervion Rept. on 
Rufz, 45 ; Catel, 20 ; Olivet, 6 ; Vincent, 7. 



I 
76 PNEUMONIA AND 

diers, seamen, and military workmen, was very numerous ; but in 
that year the wind did not blow from the south, or only occasion- 
ally, and never more than twenty-four hours at a time. It may, 
moreover, be remarked that this injurious influence of the south 
wind, or of winds from neighbouring points of the compass, is ob- 
served under the same parallels of latitude or in corresponding 
parts of our hemisphere." 

In temperate regions, the concurrence of southerly winds would 
seem to be even more requisite than it is in the West Indies, be- 
cause, in these, the long continuance of the degree of heat necessary 
for the elaboration of the malarial poison may and does exist, as is 
seen during some sickly season, without the aid of such currents ; 
whereas, in the former region, the temperature seldom if ever attains 
the degree alluded to, or remains at it long, except under the in- 
fluence of the south wind or its collaterals. Indeed, it is doubtful 
whether, in our latitudes, fevers, of a malignant character, particu- 
larly, have often been found to prevail under a very different con- 
dition of aerial currents. It was under the influence of the warm 
winds that the fever described by Hippocrates, and which is so 
closely allied to the worst forms of the malarial fevers of Algeria 
and our Southern States, appeared. The yellow fever of Anda- 
lusia, Cadiz, Carthagena, and other cities of Spain, has almost in- 
variably shown itself during the prevalence, or after a prolonged 
continuance, of the Levanter, or east wind, which is both hot and 
clamp. Such has also been generally the case at Gibraltar. 1 In 
Italy, the south and south-west winds are the usual attendants on 
fever periods. 2 In Sicily, matters are not very different. 3 In like 
manner, in this city, and other parts of the United States, the yel- 
low and other forms or varieties of malarial fevers, usually, if not 
always, break out and prevail during the continuance of south or 
some other hot winds. 4 In a word, the production and continuance 

1 Tullock's Report, 4; London Quarterly Rev. lxvi. 135, 6; Vance's Rep. in Pym, 
60; Fellows on Pestilential Fever, 13, 15, 469; Berthe Fievre J. 51 ; Pariset, F. J. de 
Cadiz, 9G ; Gilkrest, Cycl. -of Practical Med. ii. 279 ; O'Halloran on Yel. Fev. of Spain, 
14; Wilson, Fev. of Gibraltar, Chervin's Translation, 9; Rochoux, 113; Gilpin, 
Med.-Chir. Trans, v. 339; Bally, 363; Amiel, in Johnson on Trop. CI. 260; Town- 
send's Spain, 340 ; Maclean on Epidemics, ii. 485. 

2 Carriere, Climat de l'ltalie, 462 ; Valentin, Voy. MeU 45 ; Baglivi, Opera Omnia, 
157-8; Edinburgh Rev. xxxvi. 542. 3 Boyle, Edinb. J. viii. 178. 

4 Caldwell on Malaria, 135; lb. Med. Repos. vii. 144-5 ; Barnwell, 366 : S. Jackson, 
40; Waring, 23; N. 0. Rept. for 1839, 156; La Revue Mdd. for 1840, 322; Rand! 



AUTUMNAL FEVERS. 77 

of autumnal fevers — periodic and yellow, is usually connected with 
the prevalence of southerly winds ; and on inquiry it will be found 
that in instances when a different result was obtained, the thermo- 
meter had nevertheless ranged high. 

Now, how do matters stand in that respect as regards pneumo- 
nia ? If, in some localities, as at Gibraltar, for example, the disease 
prevails most usually during those periods of the year when west- 
erly winds are predominant ; if the disease also is found to occur 
more frequently in other places under the influence of different 
currents, it may be laid down as a general rule, that north, north- 
east, and north-west winds are those during the prevalence of 
which thoracic inflammations are more frequently developed. Such 
was found to be the case in the north of Italy and Germany by 
J. Frank. 1 Le Pecque de la Cloture 2 made similar observations in 
Normandy, as did also Hourmann and Dechambre, 3 and Grisolle, 4 
at Paris. Of fifty-four cases of the disease observed by the latter 
author, fifteen occurred with a north-east wind ; eleven with north- 
west ; three with north wind ; five with south-east ; eight with 
south-west, and eight during a perfect calm. Hippocrates, long ago, 
noted the prevalence of pneumonia under the influence of north 
and north-east currents in Greece. " But the following is the con- 
dition of cities which have the opposite exposure, namely, to cold 
winds, between the summer settings and the summer risings of the 
sun, and to which those winds are peculiar, and which are sheltered 
from the south and the hot breezes." " The diseases which prevail 
epidemically with them are pleurisies, and those which are called 
acute diseases." 5 Similar results have been noted in England, 6 in 
Nova Scotia, and Bermuda ; and it can scarcely be necessary to add 
that in this country pneumonia is almost invariably associated with 
the prevalence of northerly currents — N., N. E., N. W., or west. 

5. Pneumonia is of yearly occurrence — not always so fevers. — In 
connection with this subject, it may be mentioned that in places lia- 

Med. Kepos. ii. 466 ;„ Valentin, 85-6, 89; Fev. of Baltimore in 1819, 95; Archer, 
Recorder, v. 61 ; Bailey, 55 ; Townsend, 55 ; Merrill, Phil. J. ix. 233 ; Barton, Fev. 
of N. 0. in 1833, p. 9. 

1 Op. cit. 312. 2 Malad. Epid. 1st pt. 15. 

3 Arch. Gen. 2d s. xii. 30. 4 Op. cit. 141. 

5 Airs, Waters, and Places; Syd. Soc. Ed. i. 193; Littre's Tr. ii. 19-21. 

6 Cyclop, of Pract. Med. iii. 407. 



78 PNEUMONIA AND 

ble to pneumonia, the appearance of the disease is of yearly occur- 
rence. The cases may fluctuate in respect to their number. There 
may be comparatively few one year and many on another occasion. 
At other times, the disease may assume the character of an epidemic. 
But nowhere and on no occasion has it been known to disappear 
during the whole of the season at which it usually prevails, or 
during an entire year ; still less has it been known to fail entirely 
during a series of years, and to recommence its course as here- 
tofore after a long period of repose. Nor does it suddenly visit 
localities to which it had before been a stranger; and, after scourg- 
ing them for one or more seasons, disappear and be seen no more. 
The disease, being the offspring of causes which, as we shall see by 
and by, are strictly local in their character and dependent on parti- 
cular states of the sensible qualities of the atmosphere, which do 
not differ very materially in the same localities in successive years, 
must, and does consequently, show itself more or less extensively 
at each return of its appropriate season without being much, if at all, 
influenced in the frequency of its manifestation, far less prevented 
entirely, by modification in the condition of the soil or of surround- 
ing objects. 

But while such is the case in relation to pneumonia, a different 
result obtains in regard to autumnal or periodic fevers of various 
grades and types. Every one knows in this country that although 
the bilious remittent fever, the endemic of many localities from one 
extremity to the other of our vast republic, appears in such places 
to a greater or less extent, every year at stated periods, seasons 
occur at which it does so in so trifling a degree as to attract little 
notice ; and others again when it does not show itself at all. On 
the other hand, it is a fact, placed beyond the reach of doubt, that 
the disease is sometimes observed to spread extensively over a large 
expanse of country, attacking places that had been for several or 
many years almost or completely exempt from its ravages. Such 
was the case in 1822, and a few succeeding years, when the disease 
swept over immense tracts of country, in many portions of which it 
had not been heard of for many years before. Similar observations 
have been made in different parts of Europe, England, France, Spain, 
Italy. In the West Indies, many facts might be adduced in proof. 
Chisholm, in the 18th volume of Duncan's Medical Commentaries, 
describes an epidemic of remittent fever which occurred in the 
vicinity of St. George, Grenada, in 1792 ; on which occasion the 



AUTUMNAL FEVERS. 79 

disease spread in an unprecedented manner, and attacked spots 
heretofore viewed as salubrious. The following remarks by Dr. 
Imray, in relation to the endemic of Dominica, will apply equally 
to the fevers of other islands : " The causes of our endemic fevers 
reside permanently in some localities ; but in certain seasons, remit- 
tent and intermittent fevers become prevalent throughout the island." 
"Though the causes from which periodic fevers originate are per- 
manent in the country, yet do they not always operate with the 
same energy. Sometimes these morbific agencies remain in almost 
a quiescent state, and fevers occur comparatively rarely. At other 
times, they manifest unusual activity, and then we have remittent 
and intermittent fever in abundance." 1 

Still more striking are the intervals observed between the epi- 
demic manifestations of yellow fever, the elaboration of the cause 
of which is of much less frequent occurrence than that of ordinary 
autumnal pyrexia. When the disease broke out at Charleston in 
1792, it had not prevailed there during the long period of 37 years. 
It did not reign in that city from 1807 to 1817, from 1830 to 
1838, or from 1839 to 1849, and has seldom at any epoch, from 
1690 to this day, prevailed in two successive years. 2 In New 
York, it has shown itself often at long intervals; the years of 
epidemic there having been 1741, 1743, 1751, 1762, 1791, 1795, 
1796, 1798, 1804, 1805, 1819, 1822. In this city, it did not prevail 
from 1699 to 1742. It next showed itself in 1747, 1749, 1762. 
From the latter year to 1793, a period of 31 years, there was a com- 
plete, repose. The disease again showed itself in 1794, 1797; 1798, 
1799, 1802, 1803, and 1805, and lastly in 1820. From the last- 
mentioned year to the present, 1853 — when the fever again made its 
appearance, in a mild epidemic form, the number of cases not hav- 
ing reached above 170 — the city remained free from it. During 
some of these intervals, sporadic cases occasionally, but very rarely, 
presented themselves. Kindred occurrences have been observed in 
Boston, New Orleans, Mobile, Baltimore, and others of our cities ; 
in some of which, indeed, the disease has occurred on a few occa- 
sions only. "When it broke out at Cadiz, in 1800, it had not been 
seen there for 36 years ; the last visitation being that mentioned by 
Lind as having occurred in 1764. Barcelona, which suffered so 

1 Observations on the Character of Endemic Fever in the Island of Dominica. Edin. 
Journ. lxx. 284. 

2 Simons, Charleston Journ. vi. 779. 



80 PNEUMONIA AND 

severely in 1821, had not been visited by it since 1803. It had not 
been seen at Gibraltar for a century, at the time of its outbreak in 
1804. At Yera Cruz, the city was free from 1776 to 1794. If 
we except Sir "W. Pym, and a few others of the same school, physi- 
cians who are conversant with the yellow fever of the West Indies, 
whether they be contingent or absolute contagionists or anti-con- 
tagionists, have, from the days of Towne and Desportes to our own, 
admitted and continue to admit that the disease, such as it exists 
there, is a native of the soil, and prevails more frequently than 
anywhere else. And yet there is not one among them who does not 
know that the fever is not of annual occurrence in those islands. 
Sporadic cases doubtless occur frequently during some seasons. At 
others, however, they are seldom seen ; and at some again, they 
are almost, if not altogether, unknown. If we open Desportes's 
excellent work on the Diseases of St. Domingo, we shall find that in 
the course of the fourteen years he resided at the Cape, the place 
was free from the fever during five. 1 At Martinique, yellow 
fever did not appear from 1827 to 1838. Grenada, when visited 
in 1793 by the epidemic described by Chisholm, had not suffered 
for 31 years. Dominica was also exempt from 1817-1821 to 1838. 
Georgetown, Demerara, suffered severely in 1793 ; next, in 1803 ; 
then in 1819. From that year to 1837 the disease did not show 
itself in the epidemic, if indeed in any form. 2 

We find malarial fevers starting up even in times not character- 
ized by the existence of an epidemic constitution ; sometimes from a 
slight change in the local condition of the soil or of surrounding 
and sheltering objects, in spots where it had not been seen before. 
Fever has for years gradually impinged on the city of Rome. It is 
to this day spreading, and every year reaches some parts of the city 
where it was before unknown. 

On the other hand, from the operation of causes which it is not 
necessary to enumerate, fever, as we have already seen, diminishes 
or even disappears from localities where it had before prevailed 
more or less extensively. 

6. Their altitudinal range is not the same. — Every one acquainted 
with the habitat of autumnal or periodic fever must be aware that 

1 Chervin, De l'identite" des Fievres d'origine Paludeenne de differens type, 5-33. 

2 Frost, Med. Repos. 12 and 13 ; Blair, Some Account of the Last Yellow Fever 
Epidemic of British Guiana, 28. 



AUTUMNAL FEVERS. 81 

its cause is not exhaled, or, if so, is inoperative beyond a certain 
degree of elevation above the level of the sea; an effect due, like 
that resulting from Northern latitudes, to the absence of the aver- 
age of temperature required for the elaboration of the cause in 
question, or for rendering the system predisposed to its impress. 
But whatever be the elevation at which it shows itself, its usual 
places of abode are valleys, plain surfaces, the banks of streams, 
lakes, and the like ; while it very commonly spares high and 
well- aired situations. If it attack these — which is occasionally 
the case — the effect is often due to the cause being wafted thither 
by the wind, and sometimes, though more rarely, to the existence 
in the vicinity of sources of morbific exhalations, or of a soil which 
from its natural constitution is calculated, independently of true 
marshy conditions, to give rise to such exhalations. As regards 
the yellow fever, the altitudinal range of which is below that of 
ordinary autumnal or periodic fevers, it has never been known to 
appear on high, and rarely on hilly situations. Indeed, it has sel- 
dom, if ever, shown itself in any other than localities of a very 
opposite character. On this subject, however, I shall have occasion 
to dwell in detail in the next chapter, and need not say more about 
it at present. 

If, with these facts before us, we inquire how matters stand in 
relation to pneumonia, we shall find that, on this point, as on the 
several others already examined, the disease differs widely from 
autumnal and periodic fevers. For, while the latter cease to appear 
in localities situated at a certain degree of elevation above the level 
of the sea, in the same way as they do at certain degrees of latitude, 
no elevation of the kind has as yet been pointed out as forming a 
barrier to the production of pneumonic inflammation. Let fever 
stop as an epidemic, or endemic, or as a sporadic disease, where it 
may, the inhabitants of places where the cessation occurs, or of those 
situated beyond that limit, continue to suffer from thoracic inflam- 
mation, just as extensively and severely as those below, if, indeed, 
they do not to a greater extent. While fevers, whatever be the 
elevation above the level of the sea at which they prevail, make 
their appearance principally in the localities specified, and seldom, 
except under special circumstances, break out in high and well-aired 
situations, pneumonia, though not a stranger to low grounds, val- 
leys, and the like, prevails as widely, if not more so, on mountains, 
hills, and other similar spots. To prove this by a reference to a 



82 PNEUMONIA AND 

large number of examples, would be a work of supererogation; 
for there can scarcely be found a physician who is not perfectly con- 
versant with the fact. We know how subject the low grounds and 
miry river banks of Africa are to fever. On elevated localities, 
which in some places are comparatively free from that disease, the 
inhabitants are sufferers from pneumonia. This is the case in the 
island of Fernando Po, and other places. 1 Grisolle, though not 
prepared to admit the injurious effects of great terrestrial altitude 
in the production of pneumonia, cites the instance of a body of 
French troops encamped from the 15th of December to the 15th of 
May, on Mount Cenis, where malarial fevers are not common, if at . 
all known. Among these troops, pneumonia constituted one-fourth 
part of the diseases from which they suffered. 2 During the year 
1850, pneumonia in children prevailed to a considerable extent in 
all its various forms in West Philadelphia. Dr. Pugh, who reports 
the occurrence, adds : " And I think I may say, at least as far as 
my practice or knowledge extended, that the disease was not in- 
fluenced by locality, but was quite as common on high as low 
grounds." The same physician remarks, that fever in the same 
season extended from the locks of the Schuylkill Navigation Com- 
pany to Chestnut Street, and about five squares West of Market 
Street Bridge. " I think it may be asserted with safety that the 
farther we go West, or the more elevated the ground becomes, the 
less of that malady will be found." 3 Here then we see, in the one 
case, pneumonia prevailing most extensively on one of the highest 
ridges of the Alps, where fever does not appear, and in the other, 
while fever ceases in proportion as we ascend from the Schuylkill, 
pneumonia is not influenced in its frequency by the change of lo- 
cality. Not different are the results obtained in other elevated and 
mountainous regions of this country. " The elevation and coolness 
of the Alleghany," says another reporter, " secures the inhabitants 
entirely from the fevers peculiar to those of the first-mentioned 
division (that comprising low alluvial land, bordering the Juniata 
River), while they suffer most from those of a pleuritic, pneumonic, 
and rheumatic character." 4 

Dr. Williams 5 remarks : " Elevated districts are perhaps the more 

1 Daniel, Topogr. and Dis. of Guinea, 137-453. 

2 P. 135. 

3 Transact, of Pa. State Med. Soc. i. 47. 

4 Rep. of the Blair Cy. Med. Soc. Tr. St. Med. Soc. i. 105. 
* Cyclop, of Pract. Med. 3, 407. 



AUTUMNAL FEVERS. 83 

liable to pneumonia because they are more exposed and colder, 
whereas the humid air of low valleys, while it diminishes the inten- 
sity of the cold, relaxes more the mucous surfaces, and renders them 
the weaker points of the circulation." 

7. Fevers influenced by nature of soil — not so pneumonia. — Autumnal 
or periodic fevers, as every medical inquirer must know, are found 
to originate mostly, if not exclusively, in localities the soil of which 
presents peculiar geological characters, and is composed, in great 
part at least, of organic elements of a particular kind, or contains 
on its surface, or at a short distance beneath, substances more or 
less foreign to its composition, but giving rise, when acted upon by 
certain thermometrical, hygrometrical, and other influences, to the 
evolvement of poisonous exhalations. Experience has shown, also, 
that the cause of such fevers, whatever be its nature, possesses 
different degrees of affinity for the many substances over which it 
passes when wafted by aerial currents ; that these substances act, as 
it were, as so many attracting or repelling causes, tending to limit or 
extend the sphere of its morbid agency; and that hence while 
fever, the. efficient cause of which is evolved at some distance, 
abounds on a given stratum of soil, it spares individuals residing 
on strata of a different character. What the peculiarities of locali- 
ties thus afflicted are, will be stated in a subsequent part of these 
inquiries. Suffice it here to say, that, wherever they are found to 
exist, hygrometrical, thermometrical, and other influences aiding, 
fevers will also be found to originate, and often to abound. As 
regards pneumonia, I am not aware, and greatly doubt, that any 
facts entitled to our respect have as yet been pointed out calculated 
to connect the origin or prevalence of the disease with any geologi- 
cal formation, the peculiar composition of the soil, or the particular 
substances which may be spread on or placed beneath the surface 
of the latter. 

8. Fevers arrested by frost — not so pneumonia. — Nor is it less essen- 
tial to remark, in opposition to the views under examination, and 
in support of those here maintained, that in places where malarial 
fevers prevail during a certain period of the year, they are almost 
suddenly put a stop to, whatever be their forms or types — inter- 
mittents, remittents, and yellow — by the advent of frost. After the 



84 PNEUMONIA AND 

occurrence of the latter, localities which, before were unhealthy — 
to such an extent as not to be visited with impunity, especially at 
night — become free from such fevers, and from all diseases of a 
malarial origin. 

Now, as by the thermometric change in question, the morbid 
agent that had given rise to autumnal fevers has been destroyed, 
as proved by the cessation of its legitimate effects, and as, while this 
takes place in regard to fever, pneumonia is undisturbed as to its 
prevalence, or, indeed, is even increased in point of frequency, it is 
natural to conclude that the cases of pneumonia which continue to 
show themselves as heretofore, after the occurrence of that change, 
cannot be referred to the baneful agency of the cause in question, 
but are due to the operation of some other morbific influence, over 
which frost exercises no control, and differing, consequently, in its 
nature, from the former. If we admit this, we cannot err in admit- 
ting, also, that the same causes which gave rise to cases of pneumo- 
nia, occurring after a stop has been put to autumnal fevers by frost, 
must have occasioned the cases of that disease observed during the 
prevalence of such fevers and anterior to the advent of frost. If the 
cause which produced pneumonia after that event must, for reasons 
stated, differ essentially from that occasioning the fevers whose 
career has thus been arrested, the cause giving rise to the cases that 
appeared during the fever season must also be different from the 
febrile poison; and we hence arrive at the conclusion, already ad- 
verted to, that, when the two diseases show themselves together in 
the same place, two different sets of causes are at work, and from 
this difference of cause we have reason, to infer the existence of a 
difference in the nature of the diseases produced ; and that, when 
pneumonia is followed by, or succeeds to, fevers, it is not influenced 
in its production by the causes to which these are due. 

I am not ignorant of the fact that the salutary effects here 
ascribed to frost, of putting a stop to autumnal fevers, has been called 
in question. I am aware that, in proof of the fallacy, it is remarked 
that such fevers are encountered every month of the year ; that 
they prevail, more or less, all the year round ; and, consequently, I 
am prepared to be met with the objection that, such being the con- 
tinued prevalence of the disease, in cold as well as in warm weather, 
any argument against the etiological and pathological connection of 
pneumonia with autumnal fevers, founded on the supposed cessation 



AUTUMNAL FEVEES. 85 

of the latter through the effect of a reduction of atmospheric tem- 
perature to the freezing point, must be set aside. 

How far such an objection will influence those who have paid due 
attention to the subject, I need not inquire. Having, however, ad- 
duced the fact of that cessation, as one well established and militating 
strongly against the views under examination, I must be allowed 
to show, were it only for the benefit of those who venture on the 
denial, that what I have said in the matter is not a dream of the 
imagination — " a sheer assumption, worthy of one who is behind 
the times" — but has received the sanction of the highest medical 
authorities, in all parts of the world. Now, that in hot or very mild 
climates, malarial fevers may, and often do, continue to prevail, 
more or less, all the year round, is a position which, as every one 
conversant with the subject knows, will admit of no doubt. But the 
fact of such a continuance of the disease in those climates does 
not in any way impair the correctness of the statement made re- 
specting the aforesaid power of frost ; the explanation of the differ- 
ence being easily found in the circumstance, that in those climates 
the cold of winter does not prevail in sufficient force, or continue 
long enough, to produce the effect contended for, and decided frost 
never or seldom occurs at all. But, be this as it may in regard to 
the climates mentioned, it is indubitably true, that whenever, in a 
miasmatic district, the thermometer descends to the freezing point, 
and there remains awhile, the progress of malarial fever is arrested. 
In this vicinity, among others, every one, from the learned physician 
to the gossiping granny, knows full well that the accession of severe 
cold weather, and particularly of black frost, is sure to be marked 
by a cessation of the fevers in question, and that, in the few cases 
that present themselves after that event, the attack is ascribable to 
that power of dormancy, by virtue of which the cause of some 
diseases remains, for a greater or less length of time, latent in the 
system after exposure, and which, in some forms of fever, may be 
prolonged for weeks and even months. Had I space and leisure to 
enlarge much on this subject, and, indeed, were it necessary, I 
could demonstrate, by means of numerous quotations, that such is 
the case also in other parts of this country, and in foreign lands — 
in every place, indeed, where the cold of winter is well marked or 
the frost severe. A few references will be sufficient. Thus, in 
regard to periodical fevers, the fact of their cessation, through the 
effect of cold or frost, is recorded in the writings of the physicians 



86 PNEUMONIA AND 

of our northern and middle States, and of Canada: Eush, 1 Currie, 2 
Potter, 3 Caldwell, 4 E. H. Smith,* J- M. Smith, 6 Wood, 7 Coventry, 8 
Vaughan, 9 Lee, 10 Usher Parsons, 11 Agnew, 12 Lucas, 13 Stratton. 14 
In the South, South-west, and West, we find it mentioned and in- 
sisted upon by Taylor, 15 Eamsay, 16 Hansford, 17 Thompson, 18 Wa- 
ring, 19 Arnel, 20 Prior, 21 Smelt, 22 Dunbar, 23 Staley, 24 Dickson, 25 Hil- 
dreth, 26 Drake, 27 Simons, 28 Grant, 29 Cooke. 30 Cross we the Atlantic, 
we find the same thing taught by Sydenham, 31 Lancisi, 32 Cleghorn, 33 
Bartholin, 34 Bancroft, 36 Williams, 36 Copland, 37 Macculloch, 38 Monfal- 
con, 39 Eigaud de Lisle, 40 E. Hamilton, 41 Sir J. Pringle, 42 F. Home, 43 
G. Brown, 44 Tournon, 45 Bailly, 46 Sir Ch. Morgan, 47 Sir James Clark, 48 
Booth, 49 Carriere, 50 De Eenzi, 51 Jacquot. 52 In fact, it is mentioned 



1 Non. Cont. of Yellow Fever, Med. Repos. vi. 162. 

2 On Bilious Fever, 13, 21 ; Med. and Philos. Register, i. 181, 195. 

3 On Contagion, 16. 

4 On Miasma, 16; Med. and Phys. Mem. (1800), 202. 

5 Webster's Collection, 107. 6 On Epidemics, 71. 

7 Pract. of Med. i. 142, 267. 

8 On Lake Fever, N. Y. Med. and Phys. J. iii. 15; Tr. of Med. Soc. of the State 
of N. Y. for 1825, 42. 

9 Med. Repos. iv. 130. 
11 On Malaria. (Essays), 200. 
13 Med. Recorder, v. 420. 
15 Webster's Collection, 148. 
17 Webster's Collection, 148. 
19 N. A. Med. and Surg. J. i. 5 ; ix. 375. 
21 In Potter, op. cit. 16. 
23 Med. Repos. viii. 258. 

25 Am. J. ii. 64. 

26 Med. Repos. xi. 345; Chapman's J. ix. 109. 

27 Topdg. and Dis. of the Valley of the Miss. 608, 713. 
2S Charleston J. iv. 543. 29 Am. J. July, 1853, 112. 
30 Med. Record, vii. 453. 31 Works, ii. 191. 
32 De Noxiis Paludum Effluviis, 46. 33 Dis. of Minorca, 133. 

34 Hist. Anatomicarum, 72. 

35 Tr. on Yellow Fever, 292, 407; Sequel to do. 91. 



10 Med. Repos. iii. 252. 

12 Med. Recorder, vi. 138. 

14 Edinb. Med. and Surg. J. lxiv. 105. 

16 History of South Carolina, ii. 55-6. 

18 Chapman's Journal, x. 106. 

20 Med. and Philos. Register, ii. 10. 

22 Med. Repos. ix. 127. 

24 Med. Recorder, v. 460. 



36 On Morbid Poisons, ii. 460. 

38 On Malaria, 155. 

40 In Johnson on Trop. CI. 313. 

42 Dis. of the Army, 14, 116, 172. 

44 Cyclop, of Pract. Med. ii. 235. 

46 Traite des F. Int. Pernicieuses, 1 34. 

48 Med. Notes on Italy, 80-3. 

49 Life of Dr. Armstrong, i. 258, ii. 295 

50 Du Climat. de l'ltalie, 371. 

51 Oss. Sulla Topog. Med. del Regno di Napoli, 68; Miasmi Paludosi, 21. 

52 Des F. a Quinquina, 38. 



37 Vol. i. 759; ii. 1100. 

39 Traite' des Marais, 345. 

41 On Marsh Remit. Fever, 28, 32. 

43 Med. Facts and Observations, 46, 76. 

45 Etudes sur Rome, i. 203. 

47 Lady Morgan's Italy, i. 439, ii. 106. 



591 



AUTUMNAL FEVERS. 87 

as a well-known and indisputable phenomenon, by all who have 
written on the periodic fevers of England, Holland, Flanders, 
France, Italy, Spain, etc. Nay, in the West Indies themselves, the 
healthy season is the cool season, and the continuance of periodic 
fevers during the winter months is in direct proportion to the con- 
tinuance of heat. In warm winters fever continues; in cool ones it 
disappears in great measure, or completely. The researches of Dr. 
Drake, in reference to the Valley of the Mississippi, show that, with 
the decrease of yearly and summer heat, other conditions continuing 
unchanged, there is an abatement of the fever ; that a summer tem- 
perature of 60° is necessary to the production of fever, and the 
latter will not prevail as an epidemic when the temperature of that 
season falls below 65°; finally, that if the other conditions favour- 
ing its production are deficient, it will cease before those reductions 
of temperature have been reached. " According to these conclu- 
sions, the fever will occur in winter, at all places where that season 
has a mean temperature of 60° or upwards, as at Yera Cruz, Tam- 
pico, Havana, Key West, Tampa Bay and Fort King, and it is well 
known that cases do occur at those places, in that season ; but in 
other places, where the winter heat barely rises over 60°, they are 
few in number. At New Orleans, and generally under the 30th 
parallel, where the mean winter heat is as low as 50°, the fever is 
suspended." 

Dr. Drake farther says : " But the seasons are made up of months, 
and we are here brought to consider its connection with their re- 
spective temperatures. Up to Tampa Bay, every winter month 
rises above 60 degrees ; but at New Orleans, or the 30th parallel, 
only the nine months from March to November have that tempe- 
rature ; and as we advance to the- north, the number of months hav- 
ing it constantly decreases. Thus, at St. Louis, it is attained by 
five months only, from May to September inclusive ; at Fort Snel- 
ling, by four ; at Fort Brady, by three ; at Montreal, by four ; at 
Quebec, by three. In advancing farther north, June and Septem- 
ber fall below it ; and finally, in the distant north, July and August, 
or the entire year. Long before this reduction is reached by those 
two months, however, the fever ceases ; and, therefore, it results 
that a continuance for more than two months of a heat equal to 60 
degrees is necessary to the development of the fever." " It appears, 
from all that has been said, that within the tropics autumnal fevers 
occur throughout the year, and that, as we move northerly, the 



88 PNEUMONIA AND 

duration of its prevalence shortens, by its beginning later in spring, 
and terminating earlier in autumn. March and November first 
escape, then April and May on the one hand, and October on the 
other — lastly, June and September." 1 

So much for endemic periodic fever. If we turn to the yellow 
fever, we shall find that kindred results are obtained. That in 
some sickly seasons, in this part of the country as well as in Eu- 
rope, cases are sometimes met with several days, or (as in the 
South) some weeks after cold weather has set in, is true. But such 
results are rare, in the North particularly ; and they are most gene- 
rally the effect of the breaking out of the disease in persons who 
had imbibed the seeds of it prior to the fall of the thermometer. 
But here as elsewhere — at the North and the South — the disease 
invariably ceases as an epidemic, after a frost sufficiently severe to 
kill the leaves of trees and annual plants. 

Dr. Rush, 2 speaking of our yellow fever, says : " It is completely 
destroyed by frost." Dr. Currie 3 remarks, in reference to the epi- 
demic of 1793 : " As the weather became cold and frosty, its declen- 
sion was so rapid that it appeared as if extinguished by a miracle." 
In 1797, the Academy of Medicine 4 derived an argument in favor 
of the identity of yellow and bilious fevers, from the fact that they 
were both uniformly checked and destroyed by the same causes — - 
heavy rains and frost. And if the reader will examine the records 
of all the other epidemics by which this city has been visited — those 
of 1699, 1741, 1747, 1794, 1797, 1798, 1799, 1805, and 1820— he 
will find that they were all put a stop to, more or less suddenly, by 
the occurrence of similar changes of temperature. 

Drs. Harrison, 5 Thomas, 6 Gtos, 7 etc., of New Orleans, inform us 
that the fever of that city ceases as" an epidemic after the occurrence 
of frost. Drs. Moultrie, 8 Lining, 9 Campbell, 10 Chalmers, 11 Ramsay, 12 
Harris, 13 of Charleston, tell us much the same thing, relative to 

1 Drake, 714. 

2 Facts intended to prove the Yellow Fever not to be contagious, Wcrks, iv. 155. 
See also vol. iii. 98-9, 100, 201 ; vol. iv. 8, 45, 95. 

3 P. 2. 

4 Letters to the Governor of Pensylvania, etc. 8. 

5 Remarks on the Yellow Fever, New Orleans Journal, Sept. 1845, 130. 

6 Essai sur la F. J. d'Amerique, 110. 

7 Rapport, etc. 6, 61. 8 French Translation, 5. 
9 Essays and Observations of Edinb. ii. 409. I0 See Watts, 249. 

" Climate of S. C. ii. 60. ,2 Med. Repos. iv. 219. 

13 Barton's Journal, ii. 29. 



AUTUMNAL FEVERS. 89 

the fever of that city, which invariably ceases on the accession of 
frost or severe cold. Nor do we find matters take a different 
turn in that respect at Natchez. Of the epidemic of 1817, we are 
told by Dr. Perlee, 1 that " on the 9th of November there occurred 
a severe frost, which at once arrested its progress, and permitted 
the inhabitants to return in safety to their homes." 

The same writer, in his account of the epidemic of 1819, informs 
us that the weather became cool in the middle of November, and 
the disease began to subside. About the first of December, there 
having been a moderate frost, the Board of Health quickly informed 
the inhabitants that they could return to their homes with a reason- 
able prospect of safety. 2 In reference to the epidemic of 1823, 
the most disastrous by which that city was visited, Dr. Merrill 
remarks: "During the night of the 31st of October, a very great 
change took place in the weather. The wind changed suddenly 
from the south to the north-west, and the thermometer fell from. 
78 to 28 degrees in about sixteen hours. On the 1st of November 
it was considered safe to return to the city." 3 In testimony of the 
salutary effect of frost on that occasion, we have the farther autho- 
rity of Dr. Monette. 4 In 1825, the disease continued, with little 
abatement, until the 26th of October, when, as Dr. Merrill 5 states, 
" we had a heavy shower of rain. The next day the wind changed 
to north-west, and blew strong and cold, and during the succeeding 
night the thermometer fell to 34 degrees, which induced many fami- 
lies to return to the city." 6 Dr. Monette also remarks that the dis- 
ease continued its ravages until checked by frost and cold weather, 
about the 28th of October. 7 From the same writer we learn that, 
in 1837, "the disease continued to spread gradually, and with occa- 
sional abatements, until checked by frost, about the 25th of Novem- 
ber." 8 It may not be improper to remark that Dr. Merrill says, in 
relation to Memphis, that if the grading there "has fallen short of 
creating an epidemic of quite as gr^ve a character as similar causes 
have elsewhere, it may be owing to the modifying influences of a 
few timely showers of rain or an early frost." 9 I have now before 

1 Philad. Med. and Phys. Journ. iii. 6. 2 Ibid. 10. 
3 Ibid. ix. 255. 4 Observations, 65. 

5 Ibid. Essay, 59. 6 N. A. Med. and Surg. Journ. ii. 220. 

7 Essay, 62 ; Observ. 67. 8 Observations, 70 ; Essay, 75. 

9 Public Address on the Health and Mortality of Memphis, Memphis Medical Re- 
corder, i. 90. 



90 PNEUMONIA AND 

me a list of about ninety good and substantial authorities, who 
describe the yellow fever as it has appeared epidemically in Boston, 
New York, Providence, Wilmington, Baltimore, Norfolk, Frank- 
lin, Yicksburg, Alexandria, Galliopolis, Gibraltar, Barcelona, Ca- 
diz ; who all, like the authorities already mentioned, in connection 
with the disease as it has shown itself in this city, New Orleans, 
Charleston, and Natchez, impart to us information which I recom- 
mend to the particular notice of those who deny the destroying and 
purifying agency of frost, of severe cold, or blasts of northerly 
winds. 1 I must also recommend to their attention those instances, 

1 Dalmas, 39; Caldwell (Fever of 1805), 51; Ibid. Memoirs (1800), 209; ditto of 
1826, 124; Bally, 313, 314; Campbell, in Watts's Med. and Surg. Reg. 249; Moul- 
trie, French Trans. 5; Monette, 1st edit. 50, 60, 63; Ibid. 2d edit. 7, 63, 65, 67, 70; 
Thomas, 110, 2d edit. 14 ; Potter on Contagion, 25 ; Osgood, 17 ; Hosack, Febrile Con- 
tagion, 10; Facts, etc., by the College of Phys. 4; Diet, des Sc. Med. xv. 357; 
Davidge, 69; Caisergue', 194; Valentin, 88; Harrison, New Orleans Journ. ii. 130; 
Chalmers, Climate of South Carolina, ii. 60 ; Bancroft, 292, 407, 425 ; Ibid. Sequel, 
89, 91 ; Selden and Whitehead, Med. Repos. iv. 129, 336 ; Chisholm, Letter to Dr. 
Haygarth, 177; Currie, Med. Register, i. 181 ; Report of Philad. Acad, of Med, 7; 
Med. Rep. i. 406; Hardie, Fever of New York in 1798, 13 ; Ibid. 1822, 67, 68; Con- 
die and Folwell, Fever of Philadelphia in 1798, 81 ; Currie, Fever of 1799, 25; Ibid. 
on Bilious Fever, 15; Halphen, 62; Brown (S.), 26, 108; Pierquin, 40, 60; Townsend 
On Black Vomit, 30 ; Ibid. Fever of New York in 1822, 257-8 ; Palloni, Sulla Febbre 
Gialla, etc. 20; Dariste, 31 ; Jackson (Sam.), Fever of Philadelphia in 1820, 24; Let- 
ters on the Fever of Baltimore in 1819, 80, 113; Addom's Dissertation, 7; Hosack's 
Essays, i. 292; Shecut, 94, 100; Copland, iii. 169; Report on Fever of N. O. in 1820, 
6 ; New York Report of Quarantine, 44 ; Stone, New Orleans Journ. ii. 551 ; Pym, 2, 
8, 216; Ibid. 2d edit. 2, 65; Smith (J. M.), 81, 90, 91 ; Burnett (Sir W.), 342 ; Blane, 
(Sir G.), Dissertations, ii. 152, 155; Caillot, 107; Barton (Ed.), Fever of New Orleans 
in 1833, 6, 9 ; Chervin, Report on Mem. by Rufz, 77 ; Ibid. Letter to Monfalcon, 17, 
18; Forry, Climate of U. S. 290; Bayley, Letters from Health Office, 9; Amiel in 
Johnson on Trop. CI. 270 ; Ibid. Edinb. Med. and Surg. Journ. xxxv. 276 ; Robert 
Guide Sanitaire, i. 43; Physical Inquiry, etc. (N. Y.), 25; Gillkrest, Cyclop, of Pract 
Med. ii. 279 ; Lining, Edinb. Essays, ii. 409 ; Smith, Edinb. Med. and Surg. Journ 
xxxv. 40; Wood, i. 296; Chapman, Med. and Phys. Journ. ix. 135; Merrill, ibid, ix 
255 ; Ibid. North Am. Med. and Surg. Journ. ii. 220 ; Townsend on Plague and Yel 
low Fever, New York Journ. ii. 46 ; Emlen, N. A. Med. and Surg. Journ. v. 328 
Humboldt's New Spain, ii. 765; Fever of New York in 1805, Med. Repos. ix. 213 
Vaughan, Fever of Wilmington, 12, 20; Wheaton, Med. Repos. x. 335; Harris 
(Tucker), Barton's Journ. ii. 29; Monro, Med. Repos. iii. 136; Ramsay, ibid. iv. 219: 
Seaman, ibid. iv. 249 ; Opinion of the Medical Faculty of Baltimore on Fever of 1800 
Med. Repos. iv. 353 ; Archer, Med. Recorder, v. 61 ; Bond (Thomas), Lecture, N. A 
Journ. iv. 271; Deveze, 197; Brent, Med. Repos. ii. 390; Rayer, Fever of Barcelona. 
43, 48; Audouard, 414; Pariset, Relat. Hist. 93; Miller (Edw.), Rep. 88, 106 
O'Halloran, 118; Drake, 608; Reese (Meredith), Observations on the Epidemic of 
1819, as it appeared in a part of the city of Baltimore, 46. 



AUTUMNAL FEVERS. 91 

not difficult to be found, of vessels infected with yellow fever, and 
which have been rendered healthy, often rapidly, on reaching a cold 
climate, and passing through the ordeal of frosty weather. 1 

" In the event of a ship's company being attacked by fever," says 
Dr. Bryson (227), "whether from external or internal causes, which 
shows a disposition to become general, and to assume a malignant 
form, characterized by intensity of action, early yellowness of the 
skin, and black vomit, it will be of the greatest importance for the 
safety of all on board, that she should immediately quit the locality 
where the disease originated, and proceed, with all possible haste, 
to some colder region ; if in the south, to the southward, and, if in 
the north, to the northward, avoiding the neutral ground between 
the trade winds. The great utility of this measure was practically 
tested by the Yestal in 1885, when her crew were assailed by fever 
at Port Eoyal, in Jamaica, which did not cease, although she was 
shifted from the inside to the keys on the outside of the harbor, 
nor until after she had gone far beyond the precincts of the island, 
and entered the twenty -seventh degree of north latitude on her way 
to Bermuda. The crew of the same vessel, although not the same 
men, after having been paid off and recommissioned, were again 
violently attacked by fever whilst cruizing among the windward 
islands of the West Indies in the latter part of 1839. Instead of 
running at once to the northward, she proceeded to Carlisle Bay, 
where she remained about a fortnight ; during that time the disease 
evidently increased in malignancy, and carried off a considerable 
number of men. She was then directed to proceed to the north- 
ward, and again the disease disappeared a few days after she had 
crossed the tropics. The ship's company of the Yesuvius were 
promptly relieved of an invasion of fever by her being ordered 
from Sacrificios, where it was contracted, to Halifax." 

These facts, observed in such divers places, and attested by so 
many respectable and even eminent authorities, and which ought 
to be, and I have little doubt are, familiar to the disbelievers in the 
efficacy of frost in arresting the progress of malarial fevers, taken 
in connection with the statements made by Humboldt, in reference 
to Yera Cruz, that the vomito or yellow fever seldom begins to 

1 Trotter, i. 357; Caillot, 114; Doughty, 25; Ferguson's Recol. 143; Keraudren, 
18 ; Pym, 2d edit. 65, 127 ; Bryson, Report on the Climate and Principal Diseases of 
the African Station, 53; Barrington, Am. Journ. xii. 309; Waring, Med. Bepos. iv. 
1, 234; Allan, Edinb. Monthly Journ. xi. 326. See also cases of the Gen. Green, Med. 
Beposit. iv. 1, 234 ; of the U. S. Ship Hornet, Am. Journ. xii. 307. 



92 PNEUMONIA AND 

prevail there before the average temperature of the early months 
reaches to twenty-four degrees of centigrade thermometer (75.2 
degrees of Fahr.) ; that in December, January, and February, when 
the heat remains below that limit, and the cold is often very sharp, 
the disease usually disappears completely ; that the latter declines 
sometimes very suddenly, through the effects of the north winds 
(los nortes), an observation also made in more southern climates -, 1 
that the later these continue to blow in the spring, the later the 
fever makes its appearance ; and the sooner they commence in the 
autumn, the less apprehension is felt respecting its continuance ; 2 
all this, I say, should suffice to carry conviction to all unprejudiced 
minds. 

Nay, more, it may be mentioned, in farther corroboration of what 
precedes, that the history of the Oriental Plague, whatever may 
have been its course in some places, and under special circum- 
stances — as, for example, at Aleppo — whatever may be the usual 
order of events in Egypt and Smyrna, and however the disease 
may have comported itself during casual epidemics in other cities 
of Europe and Asia, furnishes additional illustrations of the power 
of cold and frost, in checking the progress of malarial complaints, 
among which that disease must undeniably be classed. 

The epidemic of London, in 1665, was arrested in December by 
frost. 3 " Like everything else, too, in nature," says Sydenham, in 
speaking of the plague, " it has its proper periods of increase and 
decline; it takes birth at the period given above (when spring 
passes into summer), and it rises towards maturity as the year ad- 
vances ; with the decline of the year it declines also. Finally, the 
frosts of winter transform the atmosphere into a state unpropitious 
to its existence." 4 The epidemic of Marseilles, in 1720, ceased on 
the approach of winter. 5 At Erzeroum, the capital of Armenia, the 
disease, in 1840, broke out in June, and in 1841, in August. In 
both instances, it was put a stop to by the severe cold of winter. 6 
The plague epidemics of Constantinople invariably commence in 
the summer season, and are effectually cut short by frost. 7 Yolney, 

1 Catel, 8, 9; Pym, .2, 8, 216; Caillot, 106; Dariste, 31. 

2 Humboldt, 4th ed. 765. 

3 Hancock, Laws of Contagion, 91 ; Hodges, Loimologia, 5, 27. 

4 Vol. i. 100, ed. of Syd. Soc. 5 Bertrand, Peste de Marseilles, 255. 

6 Report of Academy of Medicine, 31. 

7 Brayer, Neuf ans a Constantinople, ii. 77; Clot Bey, Traite de la Peste, 225; 
Rapport fait a l'Acad. Roy. de Med. 330. 



AUTUMNAL FEVEKS. 93 

who, among others, has noted the fact of the cessation of the disease 
on the accession of winter, says, properly : " The winter destroys 
the plague at Constantinople, because the cold is there very severe. 
The summer lights it up, because the heat is damp." In Russia 
and Poland, the same result has been noticed. If in Egypt, and 
other hot latitudes, the disease usually prevails in winter — com- 
mencing in November and ceasing in June — it is because that season 
is warm and damp. But even there, as we gather from no less an 
authority than Desgenettes, 1 while the south winds, as well as 
hot and damp air favour, if they do not occasion its development, 
the north winds, and the extremes of cold or heat, put an almost 
complete stop to it. Much the same statements are made by Lar- 
rey, 2 Clot Bey, 3 Assalini, 4 and Pugnet. 5 

Mr. E. Robertson, who, during a long stay in Syria, paid 
much attention to the subject of the etiology of the plague, says 
that the disease in Turkey and Lower Egypt can only exist in a 
temperature between sixty and eighty degrees (Fahr.), " a lower or 
higher either modifying or utterly destroying that atmospheric con- 
stitution, or those other occult causes, giving rise to its origin and 
propagation." 6 Nor can the occasional continuance of the plague 
at Aleppo, as we learn from the admirable accounts of the disease 
handed down to us by Drs. Alexander and Patrick Russell, 7 through 
the winter, after the accession of frost, and even a fall of snow, be 
cited as militating against the view here maintained. Such instances 
of continuance were isolated and exceptional. In general, the dis- 
ease has there ceased before the accession of winter — often during 
the months of August, September, and October — having begun to 
decline in July ; and frequently it has ceased later on the appearance 
of cold. In those instances, as in 1762, 8 when different results were 
obtained, the cases were few in number, and it is not unreasonable 
to attribute them partly to the latency of the poison in the system 
of persons exposed to its influence previous to the change of weather, 
and partly to the short continuance of a temperature sufficiently 

1 Hist. Med. de l'Armee d'Orient, 248. 

2 Campagnes d'Egypt, 330. 3 De la Peste, Observee en Orient, 206. 

4 Observations on the Disease called the Plague, &c. 42. 

5 Me"m. sur les Fievres de Mauvais Caractere, &c. 204. 

6 Medical Notes on Syria, Edinburgh Journal, lxii. 331. * 

7 The Natural History of Aleppo, 2d ed. iv. London, 1794; A Treatise on the 
Plague of Aleppo in 1760, 1761, and 1762. London, 1791. 

8 A Treatise, &c. 44. 



94 PNEUMONIA AND 

low to destroy completely the poison, which broke out anew on the 
accession of heat. 1 It is true that, in the neighbouring villages, 
caves, and grottoes, the disease continued some time in winter, after 
having ceased in the city ; but in these places it showed itself ex- 
clusively among the poorer classes, whose habitations, from the 
mode of their construction, their want of proper ventilation, the 
filthy condition in which they were kept, and the great heat in 
which their inmates indulged, may well be supposed to have re- 
tained the poison in sufficient force, if not to have been hotbeds of 
the pestilence, during the comparatively moderate and short winter 
of that country, where, according to Dr. A. Russell, the thermometer, 
in a series of nine years, varied in October, from 51 to 84 ; in No- 
vember, 44 to 65 ; in December, 40 to 55 » January, from 34 to 57; in 
February, from 48 to 55 ; in March, from 44 to 67 ; in April, from 
56 to 82 ; while in May it mounted up from 67 to 92. To this it 
may be added that, in most places where the plague has prevailed 
during the winter months, as in Egypt, at Malta, Toulon, Aix, 
Venice, Messina, &c, that season is not characterized by severe or 
long-continued cold weather, and a hard bleak frost is seldom if 
ever experienced. 

If, nevertheless, the statement of the purifying agency in question 
is still denied — if, while acknowledging, what no one can justifiably 
impugn, the truth of the events recorded, it is maintained that, in 
the association of the accession of frost with the cessation of fever, 
we are to recognize nothing but the occurrence of a fortuitous coin- 
cidence, we must admit that the frequency of that coincidence, and 
its manifestation in so many and diversified places, is to be viewed 
as a matter of the utmost astonishment, seeing that everywhere the 
one event is sure to follow closely on the heels of the other. 

As an offset to this it has been remarked that, in the Havana, 
the same thing happens without frost ; and that hence, when the 
latter occurs in any place, at the close of the epidemic season, we 
have no right to affirm that it produced the effect assigned to it. 
This cessation of fever without the aid of frost may be true. In- 
deed, I know full well that it is annually observed in tropical 
climates — not only in the Havana and other parts of Cuba, but in 
the West Indies generally, and on the coast of tropical America 
and of Africa. Nor could it be otherwise. There frost or intense 

1 A Treatise, &c. 45. 



AUTUMNAL FEVEES. 95 

cold is a thing never heard of, and yet fever epidemics come to an 
end. I know, also, that it has occasionally occurred in some parts 
of Europe, in the United States, and even in this very city. I know 
full well, besides, that in some epidemic visitations, observed in 
both tropical and extra -tropical regions, the disease has stopped, not 
only before the accession of frost, or cold or cool weather, but even 
before the cessation of great heat. None will be disposed to deny 
such occurrences, who have perused attentively the history of 
West India epidemics, and of those that appeared in this city in 
1803, in Mobile and New Orleans in 1848, as described by Drs. 
Caldwell, Nott, and Fenner, and in Leghorn, in 1804, as related by 
Palloni. But these facts, true as they doubtless are, do not in the 
least invalidate the reality of the power which I have, in common 
with so many others, ascribed to cold and frost ; for, from the 
circumstance that yellow fever has sometimes stopped in this coun- 
try, and usually ceases completely, or in great measure, in tropical 
regions, without the aid of frost, and sometimes before a cessation 
of high atmospheric heat, we cannot argue that frost, or severe 
cold, when occurring before the fever has been arrested in its 
epidemic course, will not produce that effect. This cessation 
often is too instantaneous, and is, besides, too constantly noticed, 
after its occurrence, to be ascribed to any other agency. The two 
results are not incompatible. While, therefore, we maintain that 
the effect arises most usually from the last-mentioned cause, we 
admit, what experience has sufficiently demonstrated, that the same 
beneficial change is also produced through other agencies — heavy 
rains, violent storms, heavy winds, especially from the north, desic- 
cating and long-continued heat and droughts, and not unfrequently 
from the want of subjects susceptible to the morbific impression of 
the poison ; and that, at times, it is brought about by a change in 
the epidemic meteoration, the evolution of ozone in the atmosphere, 
or some other purifying influence, the nature of which has so far 
eluded our researches ; a change which, as Dr. Smith 1 remarks, is, 
in effect, equivalent to the reduction of the temperature to 32° of 
Fahrenheit. The same effects have been noticed in other forms of 
malarial fevers; and every one is familiar with the fact that, in 
Egypt, where, for reasons mentioned, the plague prevails during 
the winter months, it stops in June, under the empire of the same 

1 On Epidemics, 174. 



96 PNEUMONIA AND 

parching heat which in that country arrests the progress of animal 
putrefaction. But, I repeat, were these occurrences more frequent 
than we know them really to be, they could not serve to counter- 
balance and overthrow all that has been said in support of the 
agency ascribed to frost and severe cold, in arresting the progress 
of yellow and other malarial fevers. 

Yery different are the results obtained in regard to pneumonia. 
For reasons plain enough to those who bear in mind what is known 
of the causes, habitat, and usual periods of prevalence of that dis- 
ease, the occurrence of frost, or the accession of cold weather has 
never put a stop to it. So far from it, while such a favourable change 
is thus experienced, as regards the prevalence of fevers through 
the means in question, it is found that pneumonic inflammations, 
instead of disappearing like the former, continue to show them- 
selves as though nothing had occurred. Indeed, whatever may 
be the tendency to the disease in any locality — whether the num- 
ber of cases be very large or small, and whether they occur in 
summer or autumn — the attacks multiply on the accession of the 
very influences which had put a stop to the other complaint ; while, 
after prevailing during the winter and spring, and taking the place, 
as it were, during those seasons, of that class of fevers to which 
attention has been all along called, their reign is, in its turn, more 
or less effectually arrested by the return of the atmospheric condi- 
tions under the~ empire of which those fevers are developed. Let 
pneumonia prevail on board of a ship in some warm latitude — a 
thing which has occasionally occurred — and it may be doubted 
whether the commander would gain much by steering north and 
reaching the banks of Newfoundland. The one disease, pneumonia, 
belongs more specially, as we have seen, to winter and early spring, 
and, if not arrested completely, is at least greatly diminished, in 
point of frequency, by the return of heat. The other is a disease 
of summer and autumn, and is diminished by cool weather and 
arrested by frost. Nothing could be more different. It affords a 
strong illustration of the correctness of a remark long ago made by 
Hippocrates, that the diseases of winter are put a stop to by sum- 
mer, and those of summer by winter. They are, to a certain extent, 
antipodal or antagonistic. At any rate, the occurrence above 
stated — the cessation of fever through the instrumentality of frost, 
and the continuance or increase of pneumonia after the accession of 
the latter, cannot be regarded otherwise than as an event the very 



AUTUMNAL FEVERS. 97 

opposite of that which, might be anticipated were the diseases off- 
springs of one and the same cause, and were the latter, pneumonia, 
really and substantially nothing more than a peculiar form of re- 
mittent and intermittent fever. To affirm this, in the face of the 
facts just mentioned, it will be necessary to put the syllogism thus : 
Autumnal fevers are arrested by severe cold and frost ; pneumonia 
is unaffected by such atmospheric changes, or even becomes more 
rife after their occurrence; ergo, autumnal fevers and pneumonia 
are identical, or the latter is only a peculiar form of the other. 
Again: Fevers appear and prevail in hot weather; the reign of 
pneumonia ceases on the accession of such weather ; ergo, the two 
diseases are the same ; and he who ventures to deny their identity, 
gives proof of being sadly behind the age, and ought, without loss 
of time, to imbue himself with the principles of the Baconian 
philosophy. 

Writers who uphold the opinion under examination will not, I 
trust, strive to strengthen the position they have assumed, by in- 
sisting on the circumstance that as pneumonia — which, they say, 
is really and substantially nothing more than a peculiar form of 
autumnal fevers — continues to appear after the accession of cold and 
frost has put a stop to the ordinary forms of the latter, etiologists, 
who maintain that the cause of febrile diseases generally is destroyed 
by a reduction of temperature below the freezing point, on the 
ground that such diseases disappear after that atmospherical change, 
are open to the charge of hazarding an assumption and reaching 
a conclusion unwarranted by the premises ; inasmuch as all that 
may justly be deduced from the^phenomena observed is, that some 
forms of periodic fever, not all, are arrested by the advent of cold ; 
and that the cause has been merely so modified as to cease to pro- 
duce a certain form of the disease, while it continues to possess its 
original power of occasioning certain other forms. The force of 
this objection few will feel disposed to admit ; for, before it can be 
used with success in the settlement of the question at issue, it would 
be first necessary to demonstrate a real identity or close alliance, in 
a pathological or symptomatological point of view, between pure 
pneumonia and malarial fevers. But this, as I need scarcely remark, 
has not as yet been and never can be done. I shall have occasion 
to recur to the subject more in detail hereafter. 

Of necessity, if periodic fevers are arrested by frost and cold, 
this salutary effect is due to the destruction, by this reduction of 
7 



98 PNEUMONIA AND 

temperature, of the cause of the disease, or to the sudden removal 
of one or more of the elements which enter into the composition of 
that cause. Of the nature of the latter I can entertain no doubt. 
In common with many a clever man, from time immemorial to the 
present day, I take it to be nothing more nor less than malarious 
exhalations — poisonous particles, floating in the atmosphere, and 
arising from peculiar changes in various organic substances in a 
state of decomposition. But, exclaim some of the advocates of the 
opinion under examination, all that has been said about this de- 
struction of the cause of febrile affections — admitting, for the sake 
of argument, that these do cease on the accession of frost — is an 
assumption ; for we cannot show that a thing is destroyed, the exist- 
ence of which has not been proved. Far be it from the author of 
this volume to insist on the possibility of frost destroying a thing 
which has no existence ; and if it can ever be proved that the morbific 
cause in question must be placed in that category, I shall certainly 
feel no disposition to say anything more about it. But, has this 
been done ? So far from it, we look in vain, in what has been 
written on the subject, for anything calculated to disprove the ex- 
istence and morbid agency of malaria, and yet this ought to have 
been well established before it could justly be adduced against a 
belief in the destructive power ascribed to frost, and the mode in 
which it is stated to exercise its salutary effects. 

For my part, with due deference to the judgment and learning 
of those who entertain an adverse opinion, I have no hesitation in 
saying that the more I examine the subject, the more I am con- 
vinced that those who ignore ths existence of malarious exhala- 
tions, and deny their morbific agency, labour under a great error, 
and contend for what they cannot prove. Nay, more — I am con- 
vinced that autumnal and endemic fevers, of genuine character, are 
never due to any other cause than such exhalations. Believing this, 
and holding, at the same time, what every one knows to be true, that 
pneumonic inflammations are due to very different agencies, it may 
not be improper, in order farther to show the fallacy of the views of 
those who insist on the close connection between those diseases, to 
dwell on some of the leading facts and arguments on which a belief 
in the existence of such exhalations, and in the peculiar and specific 
effects ascribed to them, is founded. I am aware that, as regards 
several of the advocates of the connection mentioned, the task is 
unnecessary, inasmuch as they admit the existence and morbid 



AUTUMNAL FEVERS. 99 

agency of malaria ; and that, while regarding periodic or autumnal 
fevers, of all grades and types, as caused by the latter, they do 
not hesitate to recognize in pneumonia a similarity of origin ; some 
applying the doctrine to all manifestations of that disease ; others, 
perhaps the greater number, restricting it to certain cases, charac- 
terized by periodical changes, and cured by remedies found success- 
ful in intermittent fevers. By others, however, a different opinion 
is entertained on the subject; and while some among them content 
themselves with remaining in doubt as to the propriety of admit- 
ting the existence of a specific febrile poison, others offer a decided 
and uncompromising opposition to the malarial origin of fever, 
holding all that has been said in its support to be a mere effect of 
a disordered imagination, and an hypothesis unworthy of this age 
of progress. The importance of the subject in its bearing upon the 
question more particularly before us, will be my excuse for enter- 
ing upon the examination of it in detail. But I must reserve it 
for a separate chapter. 



CHAPTER II. 

EXISTENCE AND MORBID AGENCY OF MALARIA. 

In the preceding chapter, attention was called to various facts 
militating against the opinion entertained, both in olden and mo- 
dern times, by some medical writers, respecting a supposed close 
connection, pathological and etiological, between pneumonia and 
periodic fevers. . In the prosecution of the inquiry, I was led to a 
consideration 01 some circumstances connected with the causation 
of the latter diseases, and, in so doing, touched frequently upon 
the subject of malaria, which was spoken of as the long admitted 
efficient agent in their production. Of the antiquity of this opinion, 
and of its very general adoption at the present day, few need be told. 

Hippocrates was of the opinion that diseases in general may be 
said to arise either from the food we eat, or the air we breathe. 
When, therefore, a disease seized on a multitude of persons of dif- 
ferent ages, sexes, and habits, he inferred that it must arise from the 
latter cause. Animals, he says, are under the influence of the air. 
Hence, in all probability, the source of diseases must not be 
sought elsewhere whenever it enters the body, either in excess, in 
deficient quantity, too suddenly, or contaminated with morbific 
miasmata. Of epidemic fevers, the cause resides in the air. If, 
under such circumstances, all animals are not affected at the same 
time, and only one species suffers from the disease, it is because all 
things, bodies, natures, aliments, are not alike, and what is proper 
or improper for one species, is not necessarily equally so for other 
species. When, therefore, the air is infected with miasms that are 
enemies of human nature, men are sick ; when, on the contrary, the 
air becomes injurious to some other species of animals, the latter 
alone is affected. (Be Flatihus, sects. 5, 6.) In his treatise on 
Airs, Waters, and Places, he attributes the greater part of the in- 
jurious effects of stagnant streams, and marshy situation, to drink- 
ing of the water therein found (sects. 7, 8, 10, 15). But there is 



102 PNEUMONIA AND 

much in that famous treatise which — especially when taken in con- 
nection with what the author remarks in his Discourse on Winds, 
just quoted, i. e. that with all we eat or drink, air rinds entrance 
into the body, and injures it when tainted with miasma — leads us to 
infer that, in his opinion, such waters do not affect the human sys- 
tem injuriously, simply by being ingested, but sometimes also by 
the miasma contained in or evolved from it. But whether, by the 
term miasma, he understood the marsh or terrestrial effluvia of 
modern times, is a question decided in the negative by some, and 
which others, as Dr. Adams, 1 consider as impossible to be determined. 
For my part, I am inclined to believe — apart from the references 
already made — that the great Greek observer, though not pointing 
out distinctly the effects of marsh effluvia in engendering the 
periodic fevers he so well describes, and having formed no 
just conception of their nature and precise sources, recognized 
the existence of miasma as a separate morbific agent ; for he com- 
mences the meteorological year from the decline of the summer 
preceding the year in which the epidemic he is about to describe 
occurs, and speaks of diseases arising from a certain succession of 
seasons. Now, as a determinate series of intemperies of several 
seasons cannot produce a special and well-defined effect on the sys- 
tem, otherwise than through the medium of exhalations of some sort 
from the earth, which are by them occasioned, we cannot greatly 
err in inferring that he had such exhalations in his mind when using 
the term. Hence it is, Hippocrates applies to the cause of epidemics 
the name of something divine — an expression which Galen, in his com- 
mentaries on the epidemics, regards as meaning alterations and affec- 
tions of the air arising from the influence of the stars. ISTor is it less 
probable he included under that same name an invisible fluid float- 
ing in the atmosphere, and occasioning in it the alteration and affec- 
tion above alluded to ; for he advocated the opinion of Pythagoras 
and Heraclitus, that all that exists under a sensible form arises from 
invisible corpuscles. But, however this may be, it is not to be for- 
gotten that neither Hippocrates, nor his contemporaries, were igno- 
rant of the fact that the atmosphere in the vicinity of marshes and 
large rivers in warm climates is unwholesome to the inhabitants ; 2 
that in his aphorisms he refers diseases to the changes of seasons 
and variations of temperature occurring during these ; and that, in 

1 Transl. i. 349 ; Syd. Soc. Ed. 2 Treatise on Regimen, ii. 2. 



AUTUMNAL FEVEKS. 103 

the third book of his Epidemics, he ascribes the fatal or pestilential 
disease observed by him, on a particular occasion, to the preter- 
natural and "unwholesome state of the atmosphere. 

Indeed, that a knowledge of the deleterious effects of certain con- 
ditions of the air in producing fever existed among the contempo- 
raries or immediate successors of Hippocrates ; that they knew full 
well that such an unwholesome air was the result of something 
extraneous, more particularly exhaling from marshy surfaces ; and 
that they were fully aware of the advantage and necessity of 
changing the physical conditions of these, may be inferred from 
many of the allegorical expressions in which they were so wont to 
indulge, as well as from some passages in the writings of ancient 
philosophers and historians. In accordance with the custom just 
alluded to, of resorting to allegorical expressions to convey important 
truths and salutary admonitions, and to communicate useful know- 
ledge, the ancient Greeks often employed the words monster, serpent, 
venomous beasts, as emblematic of marshes, and of the poisonous 
and fatal air issuing from them. It is in this sense, doubtless, as was 
long ago surmised, that we are to understand the fictions concerning 
the hydra, the chersydra, and the monster python, slain by Apollo ; 
derived, as those words are, the one from the Greek root, meaning 
putrefaction or corruption ; the others from the word water. Thus 
it is they personified the many -headed hydra under the emblem 
of a huge water-snake, whose poisonous breath infected the air, and 
imparted disease to animals that breathed it. Nor are we less jus- 
tified in inferring that the terms hydra and chersydra were allego- 
rically employed to designate the two and opposite conditions of 
marshes — the one. in which these are covered with water, the other 
in which they are left bare — hydra representing the snake con- 
cealed in the bosom of the stagnant and miry fluid, and chersydra 
meaning the desiccation, in hot seasons and regions, of those locali- 
ties, when they give issue to an air more virulent and poisonous 
than that connected with their overflow. Every one recollects the 
story of Hydra, the celebrated monster which infested the neigh- 
borhood of the lake of Lerna, in the Peloponnesus, with its number- 
less heads — one hundred, according to Diodorus Siculus; fifty, agree- 
ably to Simonides ; and nine, if we may credit Apollodorus — and 
presenting this remarkable peculiarity, that the central head was 
immortal ; and, as regards the others, as one was cut off, two imme- 
diately grew up, if the wound wasmot cauterized by fire. It was one 
of the labours of Hercules to destroy this dreadful monster ; an ope- 



104 PNEUMONIA AND 

ration he easily effected with the assistance of Iolaus, who applied 
burning iron to the wound as soon as each head was cut off. The 
allegory appears so plain as to induce many modern writers to 
adopt the views above expressed, and to consider this fable as a 
symbolical representation of the clearing and draining of the Pelo- 
ponnesus by the first authors of civilization. It was so regarded by 
some of the ancient writers themselves ; for Antipater, the stoic, 
speaks of the " exhalations from the damp or wet earth rising up 
like a winding stream with a burning force, and, after having been 
heated, darting down again in the way of a deadly serpent, poi- 
soning and infecting everything by means of its corrupting agency." 
"Kot without reason," he adds, "did Heraclitus give the name of 
arrow of Apollo to the rays of the sun, for they beget corruption 
in the dampness of the soil. Hercules, the greatest subduer of the 
foggy atmosphere in times past, was placed among the gods, for 
having destroyed the hydra ; in other words, for having reclaimed 
the marshy desert." 

Such being the case, we may infer that the early Greeks, though 
doubtless far from possessing correct notions as to the nature of 
malaria, as understood at the present day, or having an insight into 
its laws, were perfectly conversant with the deleterious effects of 
marshy surfaces; and aware, also, that the diseases incidental to 
such localities, are due not to changes in the sensible qualities of 
the atmosphere, but to a peculiar condition of the latter arising from 
the admixture of a poisonous element issuing from the stagnant 
water of marshes, and rendered still more baneful by the partial 
desiccation of the miry surface. The history of Empedocles, and 
more particularly of the means he employed to arrest the pestilence 
by which the city of Selinonte was ravaged, to which I shall have 
occasion to revert in a future chapter, would seem to prove, beyond 
doubt, that he at least was fully aware of the agency of noxious ex- 
halations in the production of febrile diseases. 

At a period less remote from our own, the Romans, without hav- 
ing a very clear idea of the manner in which malaria is pro- 
duced, expressed opinions and offered explanations of facts, which 
would do no discredit to modern etiologists ; for though differ- 
ing as to what the thing exactly was which exhaled from marshes 
(considered as a philosophical rather than practical question), con- 
taminated the atmosphere, and caused sickness, and though indulging 
in a variety of whimsical opinions on the subject, enough is found 
in their writings to show that they had recognized the unhealthiness 



AUTUMNAL FEVERS. 105 

of marshes and marshy surfaces, and ascribed the effect to some- 
thing beyond modifications in the sensible qualities of the atmo- 
sphere. Lucretius, who, though only a poet, may reasonably be 
supposed to have reflected, in his Rerum Naturce, the scientific 
views of the professional men of his time, observes (vers. 1,100), that 
the cause of epidemic and pestilential diseases may be referred to 
one or other of two sources : first, to the atmosphere, through the 
agency of germs wafted to the sickly place by the winds, in the 
same way that these impel clouds from place to place ; or, secondly, 
to the earth itself, when the latter, through means of long-continued 
rains and strong atmospheric intemperies, covered over with water 
and heated by the rays of the sun, undergoes, together with the 
remains of organic substances spread over its surface, the putre- 
factive process, and thereby gives vent to miasms and germs analo- 
gous to those before mentioned as wafted from other places. Yirgil 
sings of the emptiness of the city of Acerrae, whose population 
had been thinned by the sluggish course of the Eiver Clanius — et 
vacuis Clanius non cequus Acerris. Yarro ascribed the mischief to 
swarms of insects. "It is worthy of remark in marshy places," he 
says, "that, as they dry up, there are produced certain very small 
insects, too minute for observation by the eye ; which, being taken 
into the body by the mouth and nostrils, are the cause of difficult 
diseases." 1 

Columella writes that "a marsh ought not to be in the neigh- 
bourhood of buildings, nor military way, because, when acted upon 
by heat, it ejects a baleful poison, and engenders animals armed with 
troublesome stings, which settle upon us in the thickest swarms. 
Then, too, it emits the venomous hosts of water-snakes and ser- 
pents, freed from their winter's slime, mud, and fermentative col- 
luvies ; and from these there arise frequently obscure diseases, 
whose causes have not been investigated, even by physicians.'" 2 
When we come to inquire what these obscure diseases were, we 
find that they consisted of the several varieties of autumnal fevers. 

Palladius is of opinion that "a marsh is to be avoided upon every 
principle, especially on the south or west, or if it usually dries up 
in summer, because it generates pestilence and hostile animals," 3 
Vitruvius says that "the vicinity of marshes ought to be shunned, 
because when the morning breezes reach the house, with the rising 

1 De Ee Rustica, lib. i. cap. 12. 2 De Re Rustica, lib. i. cap. 5. 

3 De Re Rustica, lib. i. tit. 7. 



106 PNEUMONIA AND 

sun, they bring with them mists and exhalations tainted with the 
poison of the marshy brood. And this mixture of venom with 
fog is conveyed by the winds to the bodies of the inhabitants, and 
renders the place pestilential." 1 

Diodorus Siculus (xiv.) states that, at the siege of Syracuse, the 
Carthaginians, being encamped in the immediate vicinity of an 
infectious marsh, and exposed to the thick and heavy vapours issuing 
therefrom, and being moreover accumulated on a low and humid 
locality, a pestilential fever broke out among them, and gave rise 
to a large mortality. To the same cause he attributes the plague 
of Athens (xii. 58). Galen attributes the origin of epidemics to 
the state of the atmosphere, at least in a great measure, but he also 
maintains that the nature of the country may contribute to the same 
effect ; as, for example, its vicinity to a gulf like the Charonean, from 
which miasmata are exhaled. From these the air is tainted, and 
diseases are produced. Thus, in many passages of his Commentaries 
on the Epidemics of Hippocrates, he states that such diseases are to be 
referred to the first of these causes — the condition of the country in 
which they prevail ; and in another work, he openly and explicitly 
states that, for the most part, they are derived from the atmosphere 
being tainted with putrid exhalations. He ascribed a large share 
of agency in the production of the impurity of the air to intense 
heat and the decomposition of organic substances, observing that 
the putrefaction of dead bodies left unburnt on a field of battle, in 
hot weather, is a fruitful cause of pestilence, under which name 
wide-spreading fevers of various grades were then included, and 
adds that, in other cases, the impurity is occasioned by the exha- 
lations of certain marshes or lakes in the summer season. 2 

Judging from the little he says of epidemics, Celsus may be 
regarded as having entertained opinions similar to those of Hip- 
pocrates. 3 

Not very different is the opinion of Paulus aEgineta: "The 
nature of the country will also often occasion common diseases, 
either from its lying adjacent to marshes, or to some deep pit which 
emits a deleterious and pernicious exhalation." 4 

According to Hally Abbas (Theor. v. 2), the principal causes of a 
pestilential state of the atmosphere are, the nature of the country 

1 Archit. lib. i. cap. iv. 2 De Febribus DifF. lib. i. cap. 4. 

3 De Re Medicina, i. 47 ; Paris edit. 

4 The Seven Books of Paulus iEgineta; Adams's transl. i. 273. 



J 



AUTUMNAL FEVEKS. 107 

and the season of the year. The former cause produces its effects 
through means of the effluvia arising from corrupted fruits, pot 
herbs, &c, or the miasmata from marshes, cloacae or dead bodies, 
whether of men or cattle. Avicenna (iv. 1, 4) differed little from 
Galen, attributing fevers to a humid and warm state of the atmo- 
sphere, the stagnant air of caverns, the miasmata of lakes and 
marshes, and the effluvia from dead bodies. Avenzoar also 
attributes epidemic diseases to a humid and warm state of the 
atmosphere, effluvia from dead bodies, stagnant air, the miasmata 
from stagnant and corrupted waters, and unwholesome food (iii. 
1, 3). 1 

The summer and autumnal fevers of Eome and the adjoining 
territory attracted the notice of and are often alluded to by Livy, 
Strabo, Dionysius, Dio Cassius, and others; and sufficient was said 
on the subject to show that already at a very early period the cause, 
though not thoroughly understood, was not viewed as similar to 
those giving rise to ordinary diseases, but very generally ascribed 
to an impure state of the atmosphere, the effect often of the over- 
flow of the Tiber, and of other kindred occurrences. The opinion 
of the production of fevers through the agency of exhalations gave 
way to the fantasies of the Middle Ages — occult causes, conjunction 
of the planets, &c. Whatever was left of it was almost completely 
absorbed or chased away by the doctrine of the contagium, which, 
in the hands of its talented originator, Fracastorius, and of his many 
followers, was made to explain almost every epidemic disease. 
Though at all times experiencing opposition from writers, who, like 
Montanus and Yaleriola, adhered more or less strictly to the views 
of their ancient masters, the doctrine of contagion may be said to 
have remained in the ascendant till the days of Fernelius, 2 to whom 
credit is due for having been the first, after the renewal of letters, 
to show the influence of contaminated air in the production of epi- 
demics, and, as M. Eochoux has well remarked (p. 125), laid down 
the doctrine of miasmatic infection in a way which leaves scarcely 
anything to desire. Mccola Massa, Alphani, Porteus, Pare, Pisa- 
nelli, advocated opinions relative to the causes of autumnal fevers 
not very different from those generally entertained at the present 
day. 

Indeed, almost all the Galenics, down to Sennertus, comprehended 

1 See Adams's Commentaries on Paulus ^Egineta, i. 276, &c. 

2 Universa Medicina, &c, De abditis rerum causis, lib. ii. 497, 1552. 



108 PNEUMONIA AND 

the universal noxiousness of muddy and swampy places, under the 
naked words evaporation, exhalation, and emanation, and ascribed 
it to certain poisonous qualities of the air. Fracastorius him- 
self states that, in 1528, a pestilential fever prevailed extensively in 
Italy, and was caused by an extraordinary overflow of the Po, and 
consequent formation of numerous marshes. 1 Prosper Alpinus, who 
practised in Egypt from 1580 to 1584, ascribed the plague of that 
country to morbid exhalations. In reference to the pestilential 
fever of Alexandria, he remarks that opinions varied as to its cause. 
By some it was attributed to putrid exhalations arising from the 
lake of Mareotis, and conveyed to the city by the winds. Other 
physicians referred them to putrid and poisonous exhalations min- 
gling with the air, and arising from putrid and bad water- contained 
in reservoirs under the city, which were filled during the overflow- 
ing of the Kile, in order to afford a supply to the inhabitants 
throughout the year. 2 The agency of marshes, pools, pits for mace- 
rating hemp, unburied bodies of men and animals, and similar 
sources of contamination of the atmosphere, " are familiarly men- 
tioned by a writer who calls himself Troilo Lancetta, and who 
published at Venice, on the 16th of June, 1632, a short treatise on 
a pestilence then prevailing at Yenice, and on the means of arrest- 
ing its progress." 3 Eamazzini pointed out very accurately the 
causes of the epidemic fevers which for several years prevailed in 
and about Modena toward the close of the seventeenth century, 
attributing them to the action of an atmosphere tainted with many 
acid and earthy exhalations rising from a muddy, and, as it were, a 
fermented soil. 4 Bontius, who practised for several years at Batavia, 
prior to 1631, describing the state of the air, says: "It is rendered 
insalubrious, not only from its heat and moisture — the promoters of 
putridity — but also by the stagnant and marshy places with which 
the country abounds ; and the wind, blowing from the mountains, 
bring to the city from these marshes, dense, fetid, and poisonous 
exhalations, which corrupt the air." 5 Sylvius (De le Boe) traced an 
epidemic which broke out at Leyden in his time to the stagnant 

1 De Morbis Contagiosis, lib. ii. cap. vii. in Opera Omnia, 100. 

2 De Medicina JEgyptiorum, lib. i. cap. 14; 25-6. Paris, 1645. 

3 Ed. Med. J. lxxviii. 231. 

4 De constitutione anni 1690, de Epideniia qute Munitensis agris et Vicinaruni re- 
gionem, &c. Modena, 1691, 4to. 

5 De Medicina Indorum, Dialogus, i. 13. 



AUTUMNAL FEVERS. 109 

and corrupted waters from which exhaled noxious vapours, which 
remain in the lower part of the atmosphere. 1 Hoffman, when treat- 
ing of the evil results of a moist atmosphere, says : " The cause of 
all these accidents is justly and properly traced to the atmosphere, 
rendered sluggish, heavy, and destitute of elasticity, by marsh 
effluvia." 

Baglivi, whose work on the practice of physic was written about 
the close of the seventeenth century, remarks on this subject : " The 
Roman air is likewise foul and unwholesome— not in all places, 
indeed, but those chiefly where houses are wanting, and the air is 
slow and unmoved ; and, above all, in such places as lie upon the 
Tiber, or, like valleys, are hedged in by mountains, or are exposed 
to the exhalations that rise from old ruinous walls, vaults, and the 
rubbish of the ancient edifices. Hence, -it is manifest that the quar- 
ter of the Circus Maximus, lying between the Palatine and Aventine, 
the Tiber and Ostian Grate, is very unwholesome and pernicious." 2 

About the same period, Chirac, in describing the epidemic of 
malignant or yellow fever which prevailed at Rochefort in 1694, 
and was then designated under the name of plague, says of that 
place, that it is situated on the River Charente, and is sheltered 
from the north wind by a high hill and the remains of a thick 
wood. On the east side is situated a large meadow, which is almost 
annually overflowed by the river, and thereby converted into 
marshes filled with muddy and stinking water. These marshes dry 
up during the summer, and impart to the air of the port a smell of 
burnt powder, especially towards evening, when the dew begins to 
fall. To these exhalations — which he regards as always extremely 
dangerous — Chirac attributed the fever in question. This inference 
he considered natural, because he had before his eyes the results of 
observations made annually in all paludal countries, " whose inha- 
bitants are scourged by malignant fevers, which there break out, 
almost every summer, when the marshes are dried up, and the air 
becomes surcharged with the indigestible and offensive sulphurs 
which exhale from the mud. 3 By Porzio and others attention was 
called, about the same time or not long after, to the Hungarian 
fever. Finally, Lancisi, collecting all the facts and information 
already possessed, and adding many he himself had amassed during 

' Oratio de affectus epideruici Leidensis causis naturalibus dicta, 1670. 12mo. 

2 Opera Omnia: Venitiis, 1754, 81. 

3 Traite des Fievres Malignes, &c. i. 31, 141, 147. 



110 PNEUMONIA AND 

a period of observation of thirty years, made them illustrate the 
etiology of epidemic and endemic diseases in general, which he 
ascribes, as every one knows, to marsh and other exhalations. 1 

From that day to the present, the existence of a poisonous mat- 
ter floating in the atmosphere of febriferous localities, and its spe- 
cial agency in the production of autumnal fevers, have been admit- 
ted by professional men of all countries. The sources whence it is 
derived, the atmospheric conditions which favour, retard, or prevent 
its development, and the laws by which it is governed, have been in- 
vestigated; its geographical and altitudinal limits have been traced; 
the baneful influence it exercises, the various characters it assumes — 
as shown by the diversified forms of fever it produces — the modifi- 
cations it imparts to other complaints, and the particular mode of 
treatment it renders necessary, have been pointed out in many 
didactic works, and in more numerous publications of less pre- 
tension. 

The agency of malaria not universally admitted. — It is scarcely 
necessary to remark, that however evidently well founded the in- 
ference respecting this agency has appeared to professional ob- 
servers in all parts of the world ; however universally, indeed, the 
doctrine which ascribes autumnal or periodic fevers, of all grades 
and types, to the morbific influence of malarial exhalations, has 
been recognized, during along succession of years, as placed beyond 
the possibility of doubt or disputation, its advocates have not been 
left in undisturbed possession of the field. Doubts as to its correct- 
ness have been expressed ; objections have been raised ; and, by 
more than one writer, the very existence of malaria, or its agency 
in the production of autumnal fever, has been denied. And why 
should it be otherwise? The reader must be aware that it would 
be difficult to discover an admitted fact in practice, or a correct or 
plausible point in theory, whether on pathology or etiology, which 
has not, at some time, or in some place, encountered greater or less 
opposition, or whose correctness has not been flatly denied. Who 
does not know that the doctrine of the circulation met for years 
with the most strenuous opposition, and could not obtain a footing 
in some of the most renowned schools of Europe ? The remedial 
effects of antimony, of mercury, of the lancet, and other therapeutic 

1 De Noxiis Pallidum Effluviis. Dissertatio de Nativis, deque adventitiis Romani 
cocli qualitatibus, 16. 



AUTUMNAL FEVERS. Ill 

agents, have been violently opposed, and given rise to wars which, 
though less imaginary, appear almost as ludicrous to us as those 
which, as we are told, raged between the big endians and the little 
endians. The specificity of morbid action has been scoffed at, and 
the hypothesis of the unity of all diseases extolled, even by the 
clearest intellects. The utility, first of inoculation, and next of vac- 
cination, has encountered more than one virulent opponent, and the 
danger of the latter process has been insisted upon in volumes of 
large dimensions. Professional men are found in this nineteenth cen- 
tury, who, discarding the results of the accumulated experience of a 
hundred successive generations, embrace the absurdities of homoeop- 
athy, and seriously believe in the wonderful effects of a decillionth 
part of a grain of silex or charcoal. Hydropathy enumerates warm 
partisans among physicians in Europe and this country; and surely, 
if such has been and continues to be the case in relation to the seve- 
ral subjects mentioned, we cannot be surprised at rinding the ques- 
tion of the existence or morbid agency of malaria sharing the same 
fate. Hence, in Italy, Griannini, 1 Folchi, 2 Santarelli, 3 and Mienzi, 4 
have exerted themselves to controvert the long-received views on 
the subject. In France, the same opposition has been made by 
Lafont-Grouzy, 5 Eamel, 6 and Reveille* Parise. 7 

In England, Armstrong, 8 Hopkins, 9 Calvert, Pritchett, 10 Sir 
James Murray, 11 and Dundas, 12 have inscribed themselves among the 
opponents of malaria. In this country, too, the existence of this 
agent has been denied by Rumph, 13 Strobbart, 14 Jones, 15 Lee, 16 Gray- 

1 Delia Natura della febbri, cap. 2, vol. i. 110, 2d ed. ; French translation of d. 
i. 229. 

2 Sull' Origine delle Intermittent! di Roma e sua Campania. Roma, 1828. See 
N. A. J. v. for a translation of this Essay. 

3 Ricerche Interno alia causa delle Febbre Perniciosa dominento nello Stato Ro- 
mano, 32. 4 Sopra cegenesi delle febbri Interm. Roma, 1844. 

5 Caracteres Propres, Preservatifs et Remedes des Contagions, 1822. See Monfal- 
con, 47, note. 

6 De l'lnfluence des Marais et des Etangs sur le Sante des Hommes. Paris, 1802. 
Monfalcon, 527. 

7 Journal General de M6decine, xcvii. 105. 

8 The Influence of Climate on the Human Constitution, 33. 

9 London and Edinb. Philos. Magazine, 3d series, No. 86. 

10 Some Account of the African Remittent Fever, 109. 

11 Dublin Medical Press, Nov. 27, 1844. 12 Sketches of Brazil, 154. 
13 Some Thoughts on Malaria, and Doubts as to its Existence as a Source of Disease. 

Charleston J. iii. 37. H Thoughts on Malaria. Charleston J. vi. 661. 

15 Boston J. ii. 376. 16 Forry, Climates of the U. S. 109. 



112 PNEUMONIA AND 

ley, 1 Bell, 2 Merrill, 3 and a few others ; while everywhere writers 
are encountered, who, though not openly striving to disprove the 
special agency of morbid exhalations, say nothing about them, and 
content themselves with looking to other causes to account for the 
occurrence of fever. 

Objections made to the agency of malaria, various. — But while 
all these various writers unite in rejecting or ignoring the exist- 
ence of malaria, they differ widely as regards the substitute they 
propose. The one refers all the mischief to the action of heat 
on the system. A second considers atmospheric or terrestrial 
humidity as the efficient agent. A third explains all the pheno- 
mena by means of atmospheric vicissitudes— heat by day, cold by 
night. Then again, we are told that the true cause of periodic fevers 
must be sought in a low dew-point ; or in the action of fogs or of 
visible dews, " the phenomena of which are, in fact, all the pretended 
laws of miasma ;" or in the absence or deficiency of atmospheric 
electricity, or in the presence of some particular and well-known 
gas. There are not even wanting those who think that unnutri- 
tious food exercises a more powerful agency in the production of 
periodic fever than any other cause. On all these several and diver- 
sified hypotheses much has been written. Facts, and, when possible, 
experiments have been appealed to ; learning and ingenuity have 
often been displayed ; but from all I have read and seen on the 
subject, I am inclined to the opinion that the opponents of malaria 
have left the question precisely where they found it, and that, so far 
from adducing anything calculated to disprove the existence of that 
poison, or establishing the correctness of their own views, they have 
done much to involve the whole subject in inextricable confusion, 
by constantly confounding the predisposing and exciting influence 
with the efficient cause of those diseases, and raising the former to 
the dignity of the latter. Convinced of this, and of the existence 
of malaria as a distinct morbific agent ; regarding it as the special 
cause of autumnal fevers, and as completely independent of and 
distinct from those influences which give rise to pneumonic inflam- 

1 Am. Med. J. N. S. xvii. 53. 

2 On Miasm as an alleged Cause of Fever. Philad. J. of Medical and Physical Sc. 
ii. N. S. 274. 

3 Address to the Memphis Med. Soc. on the Sanitary Condition of that City. Mem- 
phis Med. Recoixler, i. 99. 



AUTUMNAL FEVERS. 113 

mation, and, as a consequence, being persuaded that the reality of 
this agency, if satisfactorily established, must lend a powerful aid 
in the refutation of the views under examination, I propose in the 
present chapter, and before proceeding farther in the matter under 
consideration, to examine somewhat in detail the leading facts and 
arguments on which the malarial doctrine rests, and to note a few 
of the objections that have been raised against it. 

The appearance of fever where there are no marshes does not disprove 
the agency of malaria. — By those who reject this doctrine, it is not 
unfrequently urged in a tone of confident triumph that its advocates 
ascribe to marsh miasma those very fevers which we meet with in 
their most malignant forms in situations where there are no marshes 
existing; and that this is pertinaciously followed up, although con- 
tradicted by every day's experience. Hence, they add, if fevers 
arise without marshes, there can be no propriety in referring them 
to the agency of these, when they happen to exist in sickly locali- 
ties, for the sickness would in all probability have arisen had they 
not been situated there. All this at first sight appears plausible 
enough, and may prove perfectly satisfactory to those who are not 
well posted up on questions of the kind ; but, on examination, the 
objection will be found to rest on very insecure foundation. For 
when we come to inquire by whom periodic fevers are referred ex- 
clusively to the effluvia of marshes, and especially by whom the 
opinion is obstinately maintained, we easily discover that no- 
thing of the kind is insisted upon by any physician of respectable 
authority; by no one, indeed, who has directed his thoughts seriously 
to the etiology of febrile complaints. Doubtless, a large majority 
of medical writers and inquirers maintain that certain forms of 
fever are the products of marsh exhalations properly so called. 
Doubtless, also, other forms of the same disease, including the ma- 
lignant, are as generally regarded as due to the action of exhala- 
tions of some sort. But no one, or at least few, among those whose 
opinions are worth recording, think nowadays, or have thought 
for years back, of viewing the existence of a marsh as a sine qua 
non, and of pertinaciously affirming that febrile miasmata can only 
be evolved from a paludal soil. Those, therefore, who raise an 
outcry against the absurdity of such an opinion, and tax their oppo- 
nents with generally entertaining it ; those especially, who, like Dr. 
Dundas, and others of the same school, write long dissertations 
8 



114 PNEUMONIA AND 

with the view to set the world right on the subject, lose much valu- 
able time, which might be more profitably employed in making 
themselves well acquainted with the true state of the question — a 
point about which some of them appear to be lamentably deficient — 
than in refuting opinions which, if ever entertained, have long since 
been abandoned. 

That such is really the case, that the opinion which ascribes all 
fevers to the exhalations of marshes solely, is not entertained, admits 
of no doubt. Even Dr. Bancroft, whose work appeared some forty 
years ago, and would almost seem, like some others on the same 
subject, to have been written with a view to mystify the reader on 
some parts of its contents, continually confounding together, as he 
does, several distinct fevers, and applying to them the one name of 
yellow fever ; even Dr. Bancroft, I say, takes pains to explain that 
in joining the epithet marsh or marshy (which he almost invariably 
does) to the term miasmata, exhalation, effluvia, &c, and in con- 
sidering them as a cause of fever, he does not mean to intimate that 
such miasmata, &c, are emitted solely by marshes, it being certain 
that they frequently arise from soils in a different state, but only to 
designate the quality of those vapours which are eminently the pro- 
duct of marshy ground. Other writers have pointed out the impro- 
priety of viewing malaria as the production of marshy surfaces 
exclusively, as it arises often in arid places destitute of swampy 
surfaces. 1 Lancisi himself, the systematizer of the knowledge of 
the times on malarial effluvia, the discoverer of important facts, and 
the able expounder of etiological observations, who is often referred 
to, but seldom read, was very far from believing that intermittent 
and remittent fevers, which he knew full well were only modifica- 
tions of each other, proceed from the emanations of marshy grounds 
alone. On this subject he expresses himself very decidedly. 2 He 
had observed, and he records, that from the soil covered by the ruins 
of houses, temples, and public buildings, from grounds rendered damp 
and filthy by the obstructions of drains and sewers, by the over- 
flowing of the Tiber, &c, fever had arisen and prevailed extensively. 
The writings of Chervin, 3 Boudin, 4 Nepple, 5 Maillot, 6 Segond, 7 

1 J. Johnson on Tr. Clim. 24 ; Bryson, 19G. 

2 De Noxiis Paludum Effluvius, Oper. i. 73. 

3 De l'ldentite" des Fievres, d'Origine Paludeennes. 4 Ge'ographie Medicale. 

5 Traitd des Fievres Interna. Simples et Pernicieuses. 

6 Traite des Fievres ou Irritations Cereb. Spin. Interm. 

7 Mem. sur les Fievres de Cayence. 



AUTUMNAL FEVEES. 115 

Faure, 1 &c, which are usually referred to in support of the strictly 
paludal origin of fevers generally, will show that, even in the opi- 
nion of these authors, malarial exhalations of various degrees of 
virulence may, and do often proceed from surfaces presenting cha- 
racters very different from those appertaining to ordinary marshes. 
Indeed, at the present day, this existence of malarial exhalations, 
and their efficiency in the production of fever, independently of the 
presence of marshes, properly so called, and their elimination from 
sources of various nature, and differing much in external appear- 
ance, is almost universally admitted — quite so, I think, by all who 
have taken pains to investigate the subject in all its bearings; for, 
while they are firmly convinced of the reality of the morbific 
agency of such effluvia, they know that fevers prevail sometimes 
even in arid places with want of surface water, where the soil is 
rocky, or sandy, parched, and deficient in vegetation, and where, in 
a word, circumstances generally are, in appearance at least, unfa- 
vourable to the decay of organic matter. On this subject, the facts 
recorded by Ferguson, J. Davy, Craigie, Brown, Currie, Humboldt, 
and others, can leave no doubt. 2 Nay more, it is almost as gene- 
rally acknowledged, that the malignant forms of such diseases are 
never produced by the effluvia of genuine marshes, but are the 
products of other miasmal sources; while, on the contrary, fevers 
known to arise from marsh exhalations, are never produced by the 
effluvia which occasion the other forms of the disease. Hence, 
when ordinary or malignant autumnal fevers occur in places where 
no marshes properly so called exist, it is of no avail to cite the 
absence of these as an evidence of erroneous conclusions, far less 
of absurdity, on the part of those who attribute such fevers to mias- 
matic exhalations. The latter writers know, fully as well as their 
opponents, that the existence of a marsh is not indispensable to the 
manifestation of the effect in question; but, unlike them, they are 
perfectly aware of the fact that morbific effluvia, of the most deadly 
character, too, may and do arise from sources which bear no resem- 

• Des Fievres Interni. et Cont. 1833, and Gaz. Med. 1840. 

2 Ferguson on Marsh Poison, in vol. of Recollections, 185 ; Davy on Topography of 
Mediterranean, ii. 247, 248 ; Humboldt, Personal Narrative, iii. ; Charles Darwin, 
Voyage of a Naturalist, ii. 129 ; Carpenter on Periodicity, New Orleans Journal, iii. 
429 ; Caldwell, Essay on Malaria, 60, 61 ; Craigie, Practice of Physic, i. 87 ; Brown, 
Med. Essays, 33, 39 ; Currie on Bilious Fever, 55 ; Tullock, Sickness, &c. of British 
Army on West Coast of Africa, 4, &c. 



116 PNEUMONIA AND 

blance to a marsh. In the words of an intelligent writer, we may 
say: "Marshes and swamps are far from being the only sources of 
miasmata." " The foul shores of the sea ; the moist slime and mud 
of the banks of great rivers, and of mill-ponds ; the mire and mud 
in the unpaved streets, ditches, lanes, and passages of great towns 
and cities, villages, &c, particularly the cellars and damp abodes 
where the poorer classes are most frequently doomed to dwell — the 
moats of garrisons, &c. ; the soil where certain hospitals, barracks, 
or encampments are situated ; the wells and cellars, damp cells and 
dungeons of prisons, and the holds of ships, are all calculated to 
emit pyrexial effluvia from the moist earth, mud, and filth, which 
are mostly to be found within their precincts." 1 

The non-detection of malaria in the atmosphere no proof of its non- 
existence and agency. — It has been urged time after time, in oppo- 
sition to the malarial origin of fever, that the existence of the 
effluvia, to the agency of which the disease is ascribed, has never 
been proved — that their presence in the atmosphere has been in- 
ferred from the effects observed, rather than positively demon- 
strated — that they have so far eluded detection ; and that the air of 
sickly localities, whenever subjected to chemical analysis, has been 
found to contain the same ingredients, and in nearly the same pro- 
portions, as that of salubrious places. Much of this is doubtless 
true, and will not be denied by any one who has endeavoured to 
make himself acquainted with the state of knowledge on the sub- 
ject. All are aware, for the fact has been often referred to, that the 
experiments of Grattoni, and others, led to the conclusion that the 
air of the marshes of Fuentes is as pure as that of Mount Legone, 2 
one of the Grison Alps, at an elevation of 8,040 feet above the 
level of the sea. They are aware that, at Martinique, Moreau de 
Jonnes found no difference between the chemical composition of 
the air of Mount Tartanson, at a height of some six hundred feet 
above the level of the sea, and of the valley of Case Navire ; and that 
the atmosphere of the wards of the hospital of Fort Eoyal, during 
the prevalence of yellow fever, differed from neither. 3 They know 
that Julia de Fontenelle could detect no deleterious gases or foreign 
chemical ingredients in the atmosphere of infected localities — that 

1 Blackmore on Infection, 92. 

2 Memoirs de la Society de Medecine, x. 109. Art. VI. 

3 Monographic de la Fievre Jaune, 229. 



AUTUMNAL FEVERS. 117 

the latter did not vary from that of healthy places in any of the 
principles which chemical analysis enables us to discover — a result 
he obtained in the marshes of Cercle near Narbonne, at the pond 
of Pudre, at Salces, Salanque, Capestang, Cette, at Barcelona during 
the fever of 1821, and at Paris during the cholera of 1833. 1 They 
also know that a distinguished chemist and professor in the school of 
Montpellier, Berard, reached the same conclusions from his experi- 
ments on the pestiferous air of the marshes on the coast of Cette; 2 
and that Desaye obtained the same elements in the most confined 
marshes as on the most exposed hills. 3 

They are aware that, according to more recent authorities, the 
proportion of oxygen is the same in very high regions as it is near 
the surface of the earth. 4 They are, besides, conversant with the 
fact that, in more than one hundred analyses made in Paris and its 
environs, the least quantity of oxygen found was 20.913 ; the great- 
est, 20.999, and the mean, 20.96; that at Montpellier, Lyons, Berlin, 
Madrid, in Normandy, and Switzerland, the quantity varied from 
20.903 to 21.000 ; that in the port of Toulon, in the middle of the 
Mediterranean, at Algiers, in the Atlantic, between Liverpool and 
Yera Cruz, the results were the same ; that in the village of Gualla- 
bamba (Kepublic of Equador), the quantity was discovered to be 
20.960, and on the summit of Pichincha, 20.949 : 20.988 ; that, in 
eleven specimens of air collected in the southern seas, only two 
gave results differing somewhat from the above — that of the Gulf 
of Bengal, where the quantity was 20.46 : 20.45 ; and of Ganges, 
where it amounted to 20.390 : 20.387; and that in the Polar Seas, 
according to Captain Boss, similar observations were made in re- 
spect to the composition of the atmosphere. 5 They perceive from 
these results, as well as from those obtained by Levy and Brunsen, 
that the variations in the composition of the atmosphere, wheresoever 
examined, are exceedingly limited, the difference in regard to the 
volume of oxygen being from 20.9 to 21 ; that the composition of 
the air is the same in the highest attainable strata of the latter as 
on the surface of the earth; and that if, in some instances, espe- 

1 Recherches Hist. Chim. et He'd, sur Fair Mare"cageux, 91, &c. See also his trans- 
lation of Mojon's Essay on the Animalcular Origin of Cholera, 3, 4. 

2 Julia, op. cit. 93. 3 Cyclop, of Pract. Med. iii. 60. 

4 Becquerel, Des Climats et de l'lnfluence qu'ils exercent sur les Sols boises, &c. 
2, 3, 4. 

5 Regnault, Comptes Rendus, &c, de FAcademie des Sciences, xxxiv. 867. 



118 PNEUMONIA AND 

cially in hot climates, the quantity of oxygen lowers to 20.3, with a 
variation of about 0.020 of its volume, it may be doubtful whether 
such a small difference can have any influence on the phenomena of 
organic life or on health. 

" The Almighty," says a well-informed writer, "has not permitted 
the chemist to discover the nature of such attenuated exhalations : 
they elude all detection ; for if he take a volume of stagnant air 
from the foul ' plague ward' of an Egyptian hospital, where crowds 
of living and cadaverous beings are hourly stricken with the ago- 
nies of death, his analysis will prove it to contain the exact propor- 
tion by weight and by measure of elements and compounds, as 
those contained in an equal volume of a balmy breeze taken from 
a free and open English valley, where all are smiling with the in- 
estimable blessing of health, and glowing with its bronzed and 
ruddy hues." 1 

Fever not due to the action of any known gases. — Aware of all these 
failures in the attempt to refer the cause of fever to any dispropor- 
tion in the natural gaseous compounds of the atmosphere, we can 
find no difficulty in acknowledging the erroneousness of such opin- 
ions as that of Dr. Currie, who, basing his conclusion on sundry 
long-forgotten experiments of Yanbreden, thought that the insalu- 
brity of low and moist places is not owing to invisible miasma or 
noxious effluvia, but to a deficiency of oxygen resulting from ani- 
mal and vegetable decomposition ; 2 or of the once famous doctrine 
of the Septon — an undiscovered compound of azote and oxygen, as 
propounded and defended by the late Professor Mitchell, of New 
York ; or more recently, of the theories of our countryman, Eumph, 
of Giannini, and others too numerous to mention. Few, also, who 
have reflected seriously on the subject will feel disposed to lend a 
willing ear to the theory which teaches that the cause of fever must 
be sought in the admixture, in minute or larger proportion, of sun- 
dry gases, with or without addition of other substances — carbon- 
ated hydrogen, carbonic acid gas, ammoniacal gas, hydrosulphuric 
acid gas, phosphuretted hydrogen, &c. ; 3 for, were it true, that these 

1 Griffith's Chemistry of the Four Seasons, 225, 226. 

2 Philadelphia Philosophical Transactions, iv. 135. 

3 Ramazzini; Volta Opera, 3 Florence, 1816; Dumas; Pallas, 219; Faust, Amer. 
Journ. vi. 38 ; Thdnard and Dupuytren in Monfalcon, 54 ; Baumes, Emanations 
Marecageuses, in Monfalcon, 53, 54; Deslandes, Diet, de Med. prat, article Emanation; 



AUTUMNAL FEVERS. 119 

gases have been, or may be, detected in the atmosphere of sickly 
localities, it would not follow that we must ascribe fever to their 
agency, seeing that though often unpleasant to the smell, and some- 
times injurious or even fatal in their tendencies, they do not pro- 
duce phenomena analogous to those of the diseases in question, 
even when absorbed in large quantities ; while those they do occa- 
sion present always a widely different garb ; and that, as they do 
not produce the symptoms of true pyrexial complaints when ab- 
sorbed in large quantities, they are not likely to occasion them 
when received in such small proportion as to elude detection. If 
they were the legitimate cause of fever, and the active agents of 
miasma, it is impossible to understand how the fact could not have 
been demonstrated during wide-spreading and highly malignant 
epidemics, when the cause was acting with intense energy, and must 
have existed in sufficiently large proportion to be detected by some 
or other of the means within our reach. It should be borne in 
mind, too, that, when fatal, their effects are rapid, often instanta- 
neous ; that when, on the contrary, they do not occasion death, the 
immediate results very usually pass off, leaving the sufferer some- 
times more or less debilitated, but without one febrile symptom ; 
and that many of them are appreciable to the senses, and if existing 
in injurious proportions, would soon be detected. It is not less 
true, and to the purpose, that such gases may be produced or exist 
anywhere, in sickly as in healthy localities ; while fevers, on the 
other hand, occur in certain places only, within certain latitudes, and 
under special circumstances; that, in many situations, where fever 
prevails extensively, the existence of some of those gases, to any 
notable or injurious amount, has not only not been demonstrated, 
but is impossible, or improbable; and vice versa, that, in places where 
they are abundantly produced, fever never shows itself. Even 
hydrosulphurous acid gas itself, on which so much has been said 
lately in France by M. Chevreul, in England by Daniel, and in this 
country by Dr. Gardiner, in its relation to the etiology of autumnal 
fevers, will not be found, on reflection, to afford much aid in account- 
ing for those diseases. True, it may be, as Chevreul has shown 
by direct and positive experiments, that this gas is formed by 

Balme, Traite de la Contagion, 305; Chevreul, Bulletin de l'Acad. de Med. xviii. 692 ; 
Daniell, Lond. Med. Gaz. xxviii. 669, 700 ; Gardiner, Amer. Joum. N. S. v. 279 ; Me- 
lier, Mem. de l'Acad. de Med. xiii. 492; Carriere, Le Climat de l'ltalie, 311, 312; 
Humboldt, Personal Nar. iii. 188. 



120 PNEUMONIA AND 

the action of the sulphurets contained in water or the earth on 
organic matter, whether animal or vegetable, with which they come 
in contact (by which these nearly insoluble and inoffensive sub- 
stances are converted, through means of the combination of oxygen 
with the azotized matter, into soluble sulphurets), a result which has 
enabled M. Fontan 1 to explain the formation of sulphurous mineral 
waters. True it is, also, that those sulphates, together with organic 
matter, are found in most, if not in all sickly localities, and hence 
that the gas in question is also encountered there in a greater or 
less amount ; but it is not less true that, in many places, subject to 
fevers, and during wide-spreading febrile epidemics, of various 
forms, from the simple intermittent to the malignant yellow, the 
presence of this supposed agent is not evident to the senses, or to 
chemical reagents, and must, if it exist at all, do so in so small a pro- 
portion as to be inert. It should be borne in mind, besides, that 
hydrosulphuric acid gas proves innocuous in factories and bathing 
establishments 2 where it abounds; and that its presence in the 
African rivers and circumambient air, on which so much stress was 
laid by Dr. Daniell and others, 3 has been positively disproved — ■ 
water newly taken up, or kept in bottles, hermetically closed, never 
giving evident signs of that presence, which is evidently due, after 
awhile, to the putrefaction of the organic matter contained in the 
water. 4 In a word, there is not the most distant probability that 
malaria will ever be found to owe its morbific agency to, or consist 
in any extraneous gas floating in the atmosphere, or, that fevers are 
due to an excess or deficiency of one or more of the known con- 
stituents of the latter. 

Not true that nothing is found in the atmosphere of sickly localities. — 
All this we must admit ; but while doing so, we can find no valid 
reason for denying the very existence of a specific febrific cause ; 
for from the circumstance that malaria cannot justly be identified 
with any of the gases above mentioned, it does not follow that the 

1 Bulletin de l'Acad. x. 692, &c. 

2 Annales d'Hygiene, xi. 290; Brocchi Stato Fisico di Roma, 254, &c. ; J. K. Mit- 
chell, 28. 

3 Loc. cit. 

4 M'Williams, Medical History of the Expedition to the Niger, &c. 172; Pritchett, 
Some Accounts of the African Remittent Fever, 117; Edin. Journ. 63, 442; Arm- 
strong, Sulphuretted Ilydr. and its Antidotes, Naut. Mag. 1842, 378, &c. 



AUTUMNAL FEVERS. 121 

atmosphere of sickly localities contains no extraneous material to 
which autumnal fevers are to be ascribed. Certain it is, that those 
who enter into the investigations unbiased by preconceived notions 
will not lose sight of certain facts which will probably one day be 
found entitled to the particular attention of the medical inquirer, 
and lead ultimately to useful conclusions on this important matter — 
not, perhaps, by giving us at once correct notions respecting the 
real nature of the cause, or enabling us to seize the poisonous mat- 
ter and subject it to chemical analysis, but by determining its gene- 
ral nature and the class of substances to which it belongs. The 
medical reader will recollect that Moscati, the first who suggested 
the idea of condensing the water dissolved in the atmosphere of 
insalubrious places with a view to discover the effluvial principle, 
obtained by that process, in sundry experiments he instituted at 
Milan, on the air of rice grounds, and of the wards of the large 
hospital of that city, deposits of a flocculent matter, emitting a 
cadaverous odour. 1 Brocchi, at Rome, found albuminous flakes (ani- 
mal matter) in the dews of the Pontine marshes. 2 In 1812, Eigaud 
de Lisle, experimenting on the marshes of Languedoc and Pro- 
vence, collected a quantity of the dews which, when examined 
some five or six months after by Yauquelin, was found to contain 
flakes of animal matter; while the experiment of the former on fresh 
dews, collected from marshy surfaces, gave a somewhat different re- 
sult, exhibiting, as they did, common air without admixture of any 
gas, but containing alkaline salts, with vegetable and animal sub- 
stances. 3 Dumas, and before him Yolta, found an organic substance 
combined with the gases disengaged from stagnant water. Julia 
de Fontenelle and Herpin, obtained results differing but little from 
those recorded by Brocchi, so far as regards the flocculent or in- 
organic matter, while in common dew nothing of the kind was 
discovered. 4 Agreeably to the first of these experimenters, the 
air of marshes may be inodorous, but if kept six months, it 
acquires a nauseous smell — an effect not noticed in common air. 5 
Ozanam also found "a substance apparently mucous, which emitted 

1 Compendio di Cognoz. Veterin, 81 ; Monfalcon, 59 ; Levy, Hygiene, 2d ed. i. 444. 

2 Dello Stato Fisico del Suolo di Roma, 259-275. 

3 Annales Cliniques de la Soc. Prat, de Montpellier, xliv. 286 ; Julia, loc. cit. 83-84. 
An account of these experiments was addressed to Pictet, and published in the 
Bibliotheque Universelle. 

* Julia, 86-7. 5 Ibid. 90. 



122 PNEUMONIA AND 

a very fetid odour." 1 Boussingault, whose experiments were made 
in the department of Ain (France), in 1819, and subsequently in 
South America, on the banks of the Taricagua, and at Cartago, 
in the valley of the River Cauca, 2 demonstrated also the presence 
of organic matter in the air deposited with the dew. This matter 
imparted a dark hue to concentrated sulphuric acid exposed to 
miasmata during the night — the quantity varying according to 
the unhealthiness of the seasons at which the experiments were 
made. Thenard and Dupuytren found that the carburetted hy- 
drogen obtained from marshy grounds, when passed through 
water, deposited therein a peculiar putrescible matter— a result 
not obtained from the same gas disengaged in the ordinary way. 3 
In a communication made to the French Academy of Sciences, in 
1847, respecting sundry observations and experiments made by 
him on the condensation of fogs and dews, M. Gasparn states that 
from these a peculiar matter was obtained, which, on trial, was 
found detrimental to health, and fatal to sheep. The same results 
were obtained by M. Malagutti, an Italian chemist. 4 

In 1828, Messrs. Meirieu condensed the dews collected over cer- 
tain marshes situate in the department of the Grard, and obtained 
therefrom a peculiar substance possessing acid properties. 5 

Liebig tells us that "all the observations made upon gaseous 
contagious matters, prove that they also are in a state of decompo- 
sition. When vessels filled with ice are placed in air impregnated 
with gaseous contagious matter, their outer surfaces become covered 
with water containing a certain quantity of this matter in solution. 
This water soon becomes turbid, and, in common language, putre- 
fies ; or, to describe the change more correctly, the state of decom- 
position of the dissolved contagious matter is completed in the 
water." 8 Finally, a physician of our own country, Dr. Hume, Pro- 
fessor of Elemental Philosophy in the State Military Academy of 

1 Hist. M£d. des Maladies Epid. i. 

2 Recherches sur la composition de l'atmosphere, sur la possibilite de constater 
P existence des Miasmes, Ann. de Chimie et de Pliys. lvii. 148, &c. ; Gaz. Med. Aug. 
16, 1834; Am. J. xv. 544; do. six. 263; Archives, 2d S. v. 641. 

3 Monfalcon, 54. 

4 Becquerel, Traits d'Hygiene, 174, 183; Gaz. M6d. de Paris, ii. 3d series, 1847, 
p. 22; Anglada, Traite" de la Contagion, i. 34-5. 

5 Influence des Miasmes Mardcageux, sur l'Economie Animale, Montpellier, 1829, 
p. 9, referred to by Anglada, op. cit. p. 34. 

6 Agricultural Chemistry, Lond. ed. 373 ; Am. ed. 407. 

f 



AUTUMNAL FEVERS. 123 

Charleston, during some experiments made by him in that city a few 
years ago, discovered the existence of an organic matter suspended 
in the atmosphere of localities infected with the poison "of the yellow 
fever. "Whether animal or vegetable," says Dr. H., "it is impos- 
sible to determine ; but I am inclined to suspect the presence of 
both, as the odour was more like that of animal matter, while the 
charring and subsequent combustion of the carbon was indicative of 
vegetables. The positive detection of organic matter in the con- 
densed water of a presumed infected cellar, in a decidedly infected 
district, is a new fact in the etiology of the disease, and points dis- 
tinctly to the origin of our yellow fever." 1 

Whether, in the present state of knowledge on the subject, we 
can unhesitatingly connect the production of malarial fevers of all 
grades and types, with the existence of azotized flakes in the atmo- 
sphere — attributing, with Julia (pp. 121, 153), Fourcroy, 2 and others, 
the morbid effects noticed in sickly localities to particles of animal 
and vegetable matter in a state of putrefaction, and mixed with, 
and floating in, the air — I will not pretend to decide in a very posi- 
tive manner. Perhaps the fact adduced on some occasions, that 
analogous discoveries have been made in air issuing from noted 
sources of vegetable and animal putrefactions, and which, neverthe- 
less, did not give rise to malarial fevers, and that, on the contrary, 
chemists have not unfrequently failed to detect azotized flakes in the 
air of localities where fever prevails more or less extensively, may 
deter us from regarding them as exclusive agents in the production 
of those diseases. But be this as it may, the results obtained in a 
large majority of the trials made in various situations, prove very 
clearly that in marshy places, daring the precipitation of dew, flakes 
of organic matter are deposited with it ; that, in many instances, a 
similar matter has been obtained in the atmosphere of infected 
places; and surely the frequency of the occurrence, taken in con- 
nection with other circumstances that will be noticed presently, 
justifies the conclusion that the researches of chemists have not 
been as barren of results as is usually affirmed by the opponents of 
malaria, and that the azotized matter obtained during the prevalence 
of fever may very reasonably be supposed to have some agency in 
the production of the latter. 

1 Charleston Med. J. v. 24-6. 

2 Putrefaction des Substances Animales, quoted by Julia, 122. 



124 PNEUMONIA AND 

Chemists not more successful in discovering other morbid poisons in 
the atmosphere. — But let us admit that chemists have failed, in all 
places, and under all circumstances, to detect in the atmosphere of 
insalubrious localities something tangible to which the causation of 
fever may justly be ascribed ; let us also admit, for the sake of argu- 
ment, that there exists no connection, as cause and effect, between 
the azotized and putrid flakes above referred to, and the diseases in 
question, and that we are as far off now as our forefathers were 
centuries ago, from the possibility of demonstrating, in a satisfactory 
manner, the nature of the malarial poison, and to prove its inde- 
pendent existence; it is doubtful, as every attentive reader will 
perceive, whether the opponents of the malarial origin of autumnal 
fevers can derive from that acknowledgment an overwhelming and 
convincing argument in favour of their views. He must at once see, 
that if we deny the existence of febrile miasmata on the ground 
that no one has as yet satisfactorily succeeded in detecting them 
in the atmosphere, we shall be called upon to make, for the same 
reason, and for the sake of consistency, other denials, for which, I 
presume, few physicians, whatever be their opinions on the subject 
before us, can be prepared. Let us not forget that no one has as 
yet been able to detect the poison of other zymotic diseases — small- 
pox, scarlatina, measles, influenza, hooping-cough, typhus, Asiatic 
cholera, plague, &c, contagious or otherwise — and yet we know that 
they must at times float in the air, since they produce their respect- 
ive morbid effects in individuals who breathe that tainted medium; 
and under circumstances, too, which forbid the supposition that 
those attacked could have received the infection by direct exposure 
to, or contact with, the sick. Liebig, with all the facilities afforded 
by the appliances of the Griessen laboratory, and all the uncommon 
dexterity and analyzing powers he is known to possess, tried the 
experiment, but failed. The aroma of flowers, and other odorous 
substances, betray their presence in the atmosphere, through their 
effects on the olfactory nerves ; and yet, Cavendish and other able 
operators found no difference between pure air and that in contact 
with such substances ; and were it not for he effects in question, and 
sometimes for the impression they produce on the nervous system 
at large, they would remain undiscovered. We are told by Lind, 
that turners, in working the wood of the manchineel tree, would 
be severely affected, did they not securely guard against breathing 
its poison. A field of poppies has been known to induce a sleepy 



AUTUMNAL FEVEES. 125 

disposition in the bystanders. Yan Swieten, in the early part of 
his life, suffered repeatedly a temporary loss of memory from the 
vicinity of a plant to him. 1 The air collected in the -wards of the 
hospitals of Milan, Paris, Barcelona, and other places, in dissecting- 
rooms, in knackeries, in cemeteries, in the galleries of a crowded 
theatre, from cesspools, culverts, stables, or collections of putrid 
meat, must naturally be supposed to be impure ; nevertheless, as 
seen, it does not differ from the common atmosphere in any mate- 
rial point. In some of these instances, a little ammonia or carbonic 
acid may be found ; but the result is no t constant, and is, besides, 
of no importance, 2 for the deleterious properties of infection con- 
tinue unimpaired after these substances have been removed. Nor 
can chemists discover any difference between the pure air of the 
loftiest mountain ranges, and the air through which a dog can tell 
that a horse, a fox, or a man has passed. 3 Experiments have made 
it clear that some morbific vapours may be diffused in the atmo- 
sphere in such attenuated proportions as not to be detected by the 
smell or by chemical analysis, and yet occasion baneful and even 
deadly effects, not only on some of the lower order of animals, but 
also on the more elevated in the zoological scale. 

In addition, it may be remarked that medicines, even purgatives, 
are sometimes found to act through the medium of the air, in which 
they cannot, on analysis, be detected. In all these instances, the 
substances in question, though defying the scrutinizing efforts of 
the experimental chemist, are well known to exist in the atmo- 
sphere ; some by their peculiar odour, others by having been placed 
there purposely, and most of them by their effects on the economy ; 
and, surely, if such is the case in regard to those substances, there 
can be no reason to refuse admitting others possessing toxicolo- 
gical properties the same privilege of concealment, and to deny 
their presence on the score of their not being detected on chemical 
analysis, seeing, as we do, that effects, palpable enough in all con- 
science, follow closely on exposure to an atmosphere which many 
circumstances lead us to regard as being contaminated. From 
analogy, therefore, we may conclude, that though escaping, in con- 
sequence of their inodorousness, and the inefficiency of our means 
of analysis, the notice of casual observers, and no less the researches 

1 Means of Preserving the Health of Seamen, 24-5, note. 

2 Guyton Morveau, Ann. de Chimie, xxxix. 84. 

3 Barton, Report to the State Medical Society of the State of Louisiana, 26. 



126 PNEUMONIA AND 

of the chemist; malarial effluvia may, nevertheless, float in the 
atmosphere, in sufficient amount and in a sufficient state of con- 
centration to manifest their presence by occasioning their specific 
morbid effects — febrile diseases — in individuals exposed to the in- 
fluence of the atmosphere which they serve to contaminate. 

To those who adduce such an objection, it may be remarked that 
no one will venture to doubt or deny the existence, in the matter 
obtained from a variolous or vaccine pustule, or in the pus of a 
chancre, or in any other animal poison, of a particular virus capa- 
ble of infecting the system, and reproducing in it a specific disease 
similar to that whence that virus proceeds. The variolous matter 
produces smallpox, the vaccine matter occasions cowpox, the pus 
of chancre gives rise to syphilis, &c. "Well, let them inquire how 
far chemistry has gone in the way of discovering the nature of 
these particular poisons, and the particular element through which 
they derive their toxicological powers, and they will find little 
calculated to satisfy their curiosity. On this subject the science, 
so far, has not effected much more than it has in regard to the 
atmosphere of malarial localities. The analysis of the pustules of 
mild and simple smallpox, gives only fibrine, mucus, hydrochlorate 
of soda, sulphate of potassa, phosphate of lime, and water. That of 
pus furnished by smallpox complicated with petechial eruptions, 
gives the following materials : Fibrine, mucus, hydrochlorate of 
soda, hydrocyanuret of soda, sulphate of potassa, phosphate of lime, 
and water. 1 

Not one of these materials can by itself produce smallpox, how- 
ever introduced into the system. Combine them together artifi- 
cially, in whatever proportion you please, and you will not be likely 
to occasion the effect. And yet they are the only materials found 
by the chemist ; while the particular something which imparts an in- 
dividuality to the poison, and constitutes it a specific agent, has 
fled. Will any one deny, on that account, its presence during the 
analysis? The same may be said in relation to vaccine, the pre- 
dominating elements of which consist in water and albumen ; though, 
on more minute examination, it is found to contain a matter similar 
to osmazome, chlorate of sodium, chlorate of potassa, and phosphate 
of lime. Here, again, the peculiar something has vanished. 2 Similar 

1 Journal de Chimie Medicale, 1828, iv. 488; Anglada, Tr. de la Contagion, i. 205. 

2 L'lleriticr, Traite de Chimie Pathologique, 012; Anglada, i. 204. 



AUTUMNAL FEVERS. 127 

remarks are applicable to the virus of chancre, of gonorrhoea, of 
hydrophobia, of glanders, as also to the extensive class of vege- 
table poisons, all of which, when chemically analyzed, furnish, in 
various combinations and in various proportions — the first the ordi- 
nary constituent elements of animal, the other those of vegetable 
substances — but in no instance present us with the peculiar ingre- 
dient which imparts to each of those products its specific poisonous 
property. 

Again, it has been said that the blood of individuals affected with 
measles communicates the disease, when inserted into incisions 
made in the skin, and kept there by means of cotton. I say, it has 
been said ; for though the experiments which Dr. Francis Home, of 
Edinburgh, instituted on the subject, about the middle of the last 
century, and those of Speranza, during the epidemic of Milan, in 
1822, would seem to justify the conclusion, and though the high 
authority of Stoll may be adduced in its favour, 1 the success of this 
inoculation is yet open to doubt. But, admitting it to be true, and 
admitting, also, what can scarcely be denied, that in measles, as well 
as in the whole tribe of zymotic diseases, the blood is the vehicle of 
the poison, in some form or other, it is a well-ascertained fact that, 
in the present state of the science, chemistry is powerless in its en- 
deavours to discover in that fluid any anomalous element, in the 
least indicative of the presence there of the toxicological agent to 
which the disease is due. 2 Examine also the blood of individuals 
labouring under scarlatina, smallpox, vaccine, typhus, typhoid, 
cholera, or other disorders in which a peculiar poison has been at 
work, and the fluid has been morbidly affected, and you will be 
sure to fail to discover in it traces of the presence of that poison, 
of whose existence, nevertheless, there can be no doubt. In such 
blood the quantity of water, fibrine, corpuscles or residue of the 
serum may vary more or less from that contained in the healthy 
fluid. The solidity of the clot may differ, 3 but in no instance can 
we detect the specific materies morhi. 

It is not a little surprising, if not amusing, to find that while, 
by ignoring the presence in the atmosphere of a particular matter 
which, by its poisonous property, is supposed to give rise to fever, 

1 Aphorism 583, p. 202. 

2 See the experiments of Andral and Gavarret, and of Becquerel and Rodier ; see 
also Bouchat, Maladies Contagieuses, Gaz. M^d. 1848; Simon, i. 300. 

3 Simon, i. 288, 298, 325. 



128 PNEUMONIA AND 

and to which the name of malaria has been applied; in other words, 
while, by denying a separate existence to febrile effluvia, on the 
ground that chemistry has not succeeded in detecting them, the 
disbelievers in that poison seem anxious to vindicate the character 
of the science for infallibility, or at least to uphold the idea that 
it has reached, on the subject in question, its culminating point, and 
that its not having succeeded in attaining the object in view, indi- 
cates positively the impossibility of this ever being effected, profes- 
sional chemists of the highest eminence, so far from carrying their 
pretensions that high, acknowledge the deficiency of their present 
means, admit that their science is yet in its infancy, and do not 
hesitate to say that the want of success in the detection of malarial 
emanations is not to be taken as an evidence of the non-existence 
of these. The celebrated author of the Statique Chimique, Bertholet, 
somewhere says: "Besides its constituent parts, the atmospheric air 
may contain in solution different substances, which assume in it 
the elastic form, and of which some are principles of odours ; but so 
far these emanations have eluded chemical means, which can destroy 
some, but not detect them." 1 Similar admissions are made by Eas- 
pail, 2 Muldor, Van Gaens, 3 and others ; but by none more clearly 
than Sir H. Davy, who, while expressing the conviction that, by the 
progress of chemistry and physiology, success will ultimately be 
obtained on this point, says : " That a specific matter of contagion 
has not been detected by chemical means in the atmosphere of 
marshes, does not prove its non-existence. We know so little of 
those agents that affect the human constitution, that it is of no use 
to reason on the subject." 4 

Nature and condition of fever localities lead to the opinion of the 
existence of malaria. — The opinion which ascribes autumnal fevers to 
the contamination of the atmosphere by poisonous effluvia, receives 
not a little support from their very frequent association with pecu- 
liar characters and conditions of the localities where they are noticed, 
and from their absence or cessation where those characters and con- 
ditions are wanting, or have been removed by artificial or other 
means. Whenever we encounter such localities — characterized by 
a geological formation of tertiary and cretaceous secondary deposit 

• Vol. i. 2 Hist. Nat. de la SantS et de la Maladie, i. 40. 

3 Quoted by Harrison, New Orleans Journal, ii. 582. 

4 Consolation in Travel, Works, ix. 582. 



AUTUMNAL FEVEKS. 129 

with argillaceous and rich alluvial soil more or less impervious 
to water ; or where, whatever be the appearance of the soil, water 
is found at a very short distance from the surface ; or where the 
latter is dotted with marshy fields, and traversed by sluggish 
streams ; or by swampy, low, flat level land, as along the banks of 
lakes and winding streams; or by level plains, ravines, or deep 
valleys, either dried or drying on the surface, after having been 
thoroughly wet, and perchance encased between mountain eleva- 
tions, covered, as in India, with jungles; or, in the West Indies, with 
impenetrable mangroves or thick forests, and containing a large 
amount of organic remains — there we may be very certain to meet 
with fever. "It is a safe generalization to affirm," says Dr. Drake (p. 
709), "that, all other circumstances being equal, autumnal fever pre- 
vails most where the amount of organic matter is greatest, and least 
where it is least." In localities thus characterized, I repeat, we may 
almost certainly count on meeting with malarial fever in some one 
or other of its varied forms, after a certain continuance of high 
atmospheric heat. In others, differently circumstanced, we may 
safely anticipate an exemption from that disease. 1 The salt marshes 
of Normandy — about Doll, for example; the soil along the Medi- 
terranean coast of France ; the shores of the Adriatic, of Greece, 
and of Sicily; those of Sardinia, of Spain, of Crimea; the lagunes 
of Holland, from the Walcheren to Groningen ; the soil of Flanders ; 
the Pontine marshes of the Pontifical States, and the campagna in 
the vicinity of Home; the maremme of Tuscany, Lucca, and the 
Mantuan; the soil of the Bresse, of Sologne, of Dombes, of the 
vicinity of Camargue, Aigues Mortes, Marenne, Brouage, Eoche- 
fort, and other parts of France; the coasts of Batavia and Mada- 
gascar; the alluvial districts of the western and eastern coasts of 
Africa; those of Algiers, and of India; a large portion of the United 
States, from the Delaware to the Mississippi on the Atlantic coast ; 
along the margins of the lakes, the Mississippi Kiver, and other 
western streams; a large surface in South America and in the West 

1 What is termed peat bog, or peat moss, is said not to be productive of malaria. 
Many parts of Scotland and Ireland, that are occupied by large tracts of marsh, in 
■which peat moss abounds, are completely free from these fevers. The disease is never 
seen among the inhabitants near the country of the Dismal Swamp, on the frontier of 
Virginia and North Carolina. In them, the vegetable matter is subcarbonized, and 
hence insusceptible of decomposition. It is known to possess peculiar antiseptic 
qualities, which not only preserve trees and other vegetable, but animal substances, 
from putrefaction. See Acton's Treatise on Moss Earth. 



130 PNEUMONIA AND 

India Islands ; along the sea-coast, or the borders of tropical streams 
or lakes ; the river banks and low flat surfaces of Hungary ; the 
morasses of Upland, the plains of Scanea, Sudermania, and Gothia ; 
all these localities, and many more that might, if necessary, be men- 
tioned, and which are or should be familiar to every one who has 
made paludal or autumnal fever the subject of inquiry, are in 
point. They all present some one or more of the characteristics 
pointed out, and are all, at particular seasons of the year, and under 
certain atmospheric conditions, the seat of febrile affections ; while 
other places, sometimes at no great distance, but of a different 
geological formation — less swampy or less rich in organic materials, 
and possessing a different soil — are, though similarly circumstanced 
in other particulars, free from the disease. All these facts serve to 
illustrate the almost constant connection existing, as cause. and 
effect, between the kind of locality to which I have referred and 
the disease in question. 

Nor is it less certain that the yellow fever proper is traced almost 
invariably to city districts noted for filth and imperfect ventilation ; 
to the vicinity of ships, docks, or wharves; to narrow and confined 
courts and alleys not far from these; to collections of substances, 
animal and vegetable, in a state of decomposition, &c. Instances to 
that effect have been too frequently observed, and are too well 
authenticated to be denied; while the connection between the 
existence of places of the particular kind mentioned, and the ap- 
pearance of that form of fever, is too constantly found to prevail, 
to be considered simply in the light of a coincidence. 

The danger of an attach of fever increased in proportion to proximity 
to such localities. — If we approach to, or remain some length of 
time — occasionally only a few hours or moments — in those locali- 
ties, or in their immediate vicinity, we are stricken down with 
fever; if we avoid them, we escape. The South Carolinian gives 
up his plantation residence in summer, and removes to Charleston 
or to the mountains, where he is safe from the country fever. Let 
him visit his estate before the advent of frost, and especially let 
him sleep there, and he runs great risk of an attack. In yellow 
fever seasons, strangers must leave or abstain from entering the 
city; if they venture into it, they will in all probability have the 
disease. With us, in Philadelphia — as with the residents of other 
cities of the Middle and neighbouring States, and of some parts of 



AUTUMNAL FEVEKS. 131 

Europe — where infected districts are of limited extent, the disease 
is restricted to individuals who venture within the bounds of these. 
At a very few paces from the sickly spot to which they penetrated, 
and where they doubtless imbibed the seeds of the fever, people 
move about, business is transacted with perfect impunity, and 
everything often looks precisely as if the city were not the seat of 
an epidemic. By avoiding our river banks, or our meadow or 
marshy land, by remaining within the limits of the city, or select- 
ing high and dry situations in the country, Philadelphians, like 
Charlestonians, keep free from chills and fever, or remittents; by 
adopting a different course, they expose themselves to an attack. 
On the coast of the West Indies, and of Africa, as well, indeed, 
as in this country and Europe, vessels remain healthy so long as 
they keep at a distance from land. 1 But woe to them if, during the 
sickly season, they approach the shore, or enter the river streams. 
The moment they do that they become liable to the disease. Lind, 
in his work on preserving the health of seamen, states that when 
Commodore Long's squadron, in the months of July and August, 
1744, lay off the mouth of the Tiber, it was observed that one or 
two of the ships which lay nearest the shore began to be affected 
by the pernicious vapour from the land ; whilst some others, lying 
farther out at sea, at but a very small distance from the former, had 
not a man sick at the same time. (P. 67.) While in the autumn of 
1852, many British steamers and vessels of war had the yellow 
fever for going into port at St. Thomas. "Another of her ma- 
jesty's ships, the Devastation, was at St. Thomas, but did not come 
into the harbour, keeping, however, only about a mile off the town, 
and remained intact. 2 

" I have known," Sir Gr. Blane remarks, " a hundred yards in a 
road make a difference in the health of a ship at anchor, by her be- 
ing under the lea of marshes in one situation and not in the other." 3 

1 Lind. on Hot Climates, 138-178-9; Rid. on Seamen, 78; Trotter, i. 456; Eonppe, 
65 — English translation, 69; Rush, iii. 83; Bancroft, 171 ; lb. Sequel, 166; Clark on 
Long Voyages, i. 124; Moseley, 57; H. McLean, 26; Ferguson's Recollections, 151; 
Gillespie, 20; Fontana, 12; Bally, 455; Pringle, 57, 98; Chervin's Letter to Dr. 
Monfalcon, 12 ; Burnett, 264-274; Caldwell's Prize Diss. 139; Caldwell's Essay on 
Mai. in Boston Journ. 510; Williams's Morbid Poisons, ii. 446; Smith, Edinburgh 
Journ. xxxv. 49; Ami el, Edinburgh Journ. xxxv. 264; Johnson, Charleston Journ. 
iv. 160. 

2 Wiblen and Harvey on Yellow Fever, Lancet, April, 1853, Am. ed. 322. 

3 Diseases of Seamen, 228. 



132 PNEUMONIA AND 

It is stated by masters of ships that during the prevalence of the 
late fever epidemic in Brazil, though they came direct from Europe, 
and held communication with no vessel of any kind on their pas- 
sage, the disease made its appearance on board their ships as soon 
as they approached the coast, and came within the influence of the 
land breeze. Dr. Gavin states that when the yellow fever broke 
out in Georgetown, Demarara, at the end of 1851, some seamen 
arriving from Europe were attacked with the disease on nearing the 
coast and getting into the muddy water, some days before their 
arrival in harbour. 1 

Lind states, in his well-known work on Hot Climates, that "many 
persons escaped the yellow fever which prevailed in Pensacola, in 
1765, by retiring to the ships which lay in the harbour." (179.) In 
another place the author remarks : " When the violent and fatal 
sickness raged at Cadiz, in 1764, it did not extend its influence to 
any ship which lay at a distance from the city." His majesty's 
ship, the Tweed, which was then at anchor in Cadiz Bay, like others, 
escaped. All the sick that were sent on board recovered, no bad 
symptoms appearing in their fever, " while a disease similar to the 
black vomit and the yellow fever, and equally mortal, depopulated 
that large city." (lb. 178.) Commodore Mitchell's fleet, which 
anchored in the year 1747, between South Bevel and and Walche- 
ren, were perfectly healthy, while the soldiers, on shore, at the same 
time, and at no great distance, were sorely afflicted with fever." 2 

Dr. Kush says, of the epidemic of 1793: "I heard of some sea- 
faring people who lived on board their vessels, who escaped the 
disease." 3 Dr. Caldwell remarks "that marsh malaria cannot reach 
the crew of a ship lying at anchor but a cable length from the 
shore, where it is generated:" and adds : "Similar facts may be col- 
lected from the history of yellow fever in our own country. During 
the prevalence of that disease in Philadelphia, many individuals, 
and several whole families, are known to have retreated to vessels 
lying not more than from two hundred to two hundred and fifty 
yards from the wharves, and to have remained healthy. In New 
York and Baltimore like instances have occurred." 4 

Who is unacquainted with the fact, noticed in diverse latitudes, 

1 Second Report on Quarantine, pp. 14, 15; London, 1852. 

2 Pringle, Rouppe, and Lind. 3 Op. cit. 
4 Prize Dissertation, Boston Journ. iii. p. 510. 



AUTUMNAL FEVERS. 133 

that while, in vessels at a short distance from infected localities, 
those who remain on board are exempted from fever, the boat 
crews, who, from the nature of their duties, are obliged to ex- 
plore the river banks, those who land on business or for recreation, 
are, especially if they sleep on shore, sooner or later attacked. 1 

On the other hand, vessels that are infected in such localities lose 
the fever (if they themselves do not contain sources of infection) by 
shifting their position, and anchoring at a distance — sometimes at a 
very short one — from the shore; or by going to sea, and thereby 
placing themselves beyond the influence of the land air. The 
morbific agency (in Georgetown, Demerara) seemed to moA~e in 
shifting swarms or vortices, hovering over a vessel here and there. 
"Thus, in the beginning of 1839, the Thomas King lay in the divi- 
sion A, between Kingston and Wighart's Stellings. In one week 
she lost four hands. She unmoored, and took her station outside, 
or to the leeward of the Louisa Baillie ; the mortality ceased, and 
the health of the crew became re-established. The Louisa Baillie, 
that had been right abreast, and sheltered by the Thomas King be- 
fore the unmooring, and had no death, although several cases of 
fever, which *readily yielded to treatment, became soon very sickly; 
she lost four men, after which she shifted her moorings, and the 
mortality then ceased in her also. 2 These effects have been observed 
on frequent occasions in Europe, in the \Yest Indies, on the coast 
of Africa, as well as on our western lakes. 3 

I am informed by Mr. Martin, surgeon of the Cananeuch, a Gui- 
nea trader (Dr. Lind states) that when he was in Gambia Eiver, in 
company with four other ships, the men in one of those ships were 
daily taken ill of fevers and fluxes, and several of them delirious ; 
while all the English in the other ships and in the factories were in 

1 Badenock, Med. Obs. and Inq. iv. 157-8 ; Trotter, Med. Naut. ii. 86 ; Bally, Ty- 
phus d' Am. 455 ; Clark on Long Voy. i. 38-40 ; Boyle, 75 ; Kouppe, pp. 65, 75 : Gil- 
lespie, 20; J. Hunter, 17; Valentin, 77; Caillot, 200; Bancroft, 172; Ibid. Sequel, 
166; J. Wilson, 66; Fontana, 12; Blane on Seamen, 92, 392; Lind. 106, 108, 134, 
162, 195; Lind. on Seamen, 73, 77-8; J. Johnson, 63-5, 127, 134; J. Wilson, Stat, 
of Brit. W. I. Squadron, 85; Bryson, 151, &c. &c. ; Burnett, 188-225, 268; Smith, 
Edinburgh Journ. xxxv. 13, 47, 50 ; Allon, Edinburgh Monthly Journ. Aug. 1847 ; Bry- 
son, Stat. Rep. on the Health of the (Brit.) Xavy, 215, 220, 230. 
• 2 Blair, 36. 

3 Lind. 200 ; Rid. on Seamen, 85 ; Ferguson's Recol. 143 ; Trotter, i. 358 ; Hunter, 
16; Keraudren, 18; H. McLean, 26; Rufz. Report, by Chervin, 60; Usher Parsons's 
Dissertations, 203; Cooke, Med. Recorder, vii. 451. 



134 PNEUMONIA AND 

perfect health. ; but upon removing that ship about half a league 
from her first anchorage, which was too near some swamps, her men 
became as healthy as those in the other ships. 1 

Sir G. Blane remarks : " When ships watered at Kockfort (Ja- 
maica), they found that if they anchored close to the shore, so as 
to smell the land air, the health of the men was affected ; but upon 
removing two cables' length no inconvenience was perceived." 2 

These effects are not due to heat alone. — Now, how is all this to 
be accounted for ? Notwithstanding all that has been said to the 
contrary by Towne, 3 Poissonniere, 4 Madrid, 5 Hosack, 6 Tommasini, 7 
Faure, 8 Yatable, 9 Girardin, 10 Bertaud, 11 Bourdon, 12 Dickinson, 13 and 
many others, we may safely affirm that excessive, great, or long- 
continued heat, will certainly not do so. Unaided by a more effi- 
cient morbific agent it has in no instance been found to occasion a 
remittent, an intermittent, a yellow or a pestilential fever. It is 
a well-ascertained fact that in many localities where the heat is 
intense, fever is seldom if at all observed, while it prevails more 
or less extensively in places where the temperature is considerably 
lower. The summer heat of the southern portion ,of the great 
desert is very great ; but, as Dr. Drake remarks, those who traverse 
it, and keep at a distance from its watercourses, pass the season 
unaffected. The same writer calls attention to the fact that the 
sandy banks of Pensacola Bay, from its entrance up to the town of 
Pensacola, suffer but little; while at the head of the bay, where 
extensive alluvial deposits have been made, the fever has been so 
constant and fatal as to prevent permanent settlement. Yet the 
temperature of both localities is the same, for they are but ten miles 
apart. In some localities, as the Antilles generally, fevers are said 

I Lind on Hot Climates, 180. 2 Diseases of Seamen, 178. 

3 A Treatise on the Diseases most frequent in the West Indies ; and herein more 
particularly of those which occurred in Barbadoes. Lond. 1726, 11. 

4 Traite des Fievres de St. Domingue. Paris, 1780, 50. 

5 Ensayo Analitico Sobre la Naturaliza, Causas y Curacion de las Calentnras, &c. 
Habana, 1821, pt. ii. 1. 6 Practice of Medicine, 390. 

7 Sulla Febbre di Livorno, 1804 ; Sulla Febbre Gialla Americana, \ 84, i. 168. 

8 Fievres Intermittentes et Continues, &c. 43, 44. 

9 Ann. Maritimes, 1828, 330. I0 Essai sur la F. J. 44. 

II Dissertation sur les Maladies que les Medecins de St. Domingue ont appelde 
Fievre Jaune, 7. 

12 Consid6rations sur la Prophylactique de la Fievre Jaune, 7. 

13 Observations on the Inflam. Endemic, &c. or Yellow Fever, 84, &c. 



AUTUMNAL FEVERS. 135 

to be now more rife than they were formerly, though the tempera- 
ture was not lower then than it is at the present day. The savan- 
nahs or natural prairies of French Gruiana, the arid deserts of Peru, 
and a large portion of Spanish Guiana, furnish us with examples of 
the sort. 1 Thermometrical observations made in the plains of Meta, 
situate on the east side of the oriental Cordilleras and in the valley 
of the Magnaline on the west of the same ridge, exhibit great simi- 
larity of temperature, yet the former is remarkable for insalubrity, 
while the latter is free from fever. 2 

The range of the thermometer in Antigua and Barbadoes, is 
rather higher than in Dominica, Tobago, Jamaica, or the Bahamas; 
yet we find that the troops in the latter stations suffer nearly three 
times as much as those in the former. 3 The yellow fever does not 
prevail on Pigeon Island, but is of common occurrence in the town 
of Castries, 4 though the temperature is much the same in both 
places. While common in some parts of the coast of Africa, the 
same disease is rare in Senegal. 5 It is rare also in Cayenne, which 
is, to say the least, as hot as any place within the tropics. 6 Panuco, 
and the plains of Coro and Cumana, and the coast of Coromandel 
and of Onixa, cited by Humboldt, 7 as well as the coast of Malabar, 
the deserts of Arabia, and of the Diabakie 8 are rarely the seat of 
malarial fevers, especially of those of a malignant character. The 
same may be said of Lima, Brazil, Peru, 9 the savannas or natural 
prairies of French and a large portion of Spanish Guiana, 10 where, in 
spite of excessive and long-continued heat, this fever does not exist. 

The prevalence of and mortality from fever have also been found 
in the same place far greater in some seasons than in others — the 
temperature remaining nearly the same; 11 and it has originated and 
prevailed in some situations — as well in the West Indies, in Africa, 
in Europe, as in this country — nearly as often when the range of 
the thermometer was at the minimum of tropical heat as at the 
maximum. 12 

1 Leblond, 6, 62-4-5. 

2 Boussingault, Annales de Chimie, lvii. 153. 

3 Report on Mortality in British Army, 101. 

4 Pugnet, 342. 5 Thevenot, 244. 
6 Bajon Mem. sur Cayenne, 29, 59. 7 Volume i. 62. 

8 Bonneau et Sulpici, Recherches sur la Cont. de la F. J. 16. 

9 Vicaire, Annales Maritimes, Oct. 1831, 298^9. ,0 Leblond, 6, 62-4-5. 

11 Sickness, &c, in British Army, 5, 101 ; Craigie's Practice, i. 224-6. , 

12 Report of Sickness of British Army, 26 ; Cartwright's Recorder, ix. 226 ; Blair, 52. 



136 PNEUMONIA AND 

This want of necessary connection, as cause and effect, between 
high atmospherical heat and fever — common autumnal and yellow 
— has been pointed out by a large number of writers on these 
diseases as they show themselves in various parts of the globe. 1 

Again, heat is greater in cities than in the surrounding country, 
and yet malarial fevers are more frequently encountered in the 
latter than in the former. And if the cause of yellow fever is more 
frequently evolved in cities, it is because it requires a higher de- 
gree of temperature. But even this will not serve to disprove my 
position ; for, during the existence of the disease, many localities in 
the close vicinity of, and just as hot as, the part infected, remain 
healthy. Indeed, in insalubrious regions fevers are more particu- 
larly rife, not during the hottest months of the season, but some time 
after, when the average temperature has lowered in a notable degree. 
Such has been found to be the case in Gibraltar, 2 in France, 3 in this 
city, 4 in Charleston, 5 Barcelona, 6 the West Indies, 7 Algeria, 8 &c. 
It may be mentioned, also, that fevers often cease long before the 
cessation of hot weather — when, indeed, the temperature has reached 
its highest point. We know that such is the case in relation to the 
Egyptian plague, and that it has occurred also at Dantzic, Toulon, 
and Stockholm. 9 "There broke out a plague in Venice," says 
Matth. Yillani, an eye-witness {Lib. i. Historiar.), "in the year 
1348, in the month of March. It was at its height in April and 
May. It began to decline in July, and ended in August ; so that a 
plague will end in hot weather." 10 The occurrence has been noted 
in reference to the yellow fever ; and in South America, this coun- 

1 Copland, iii. 151; Bryson, 197; Dazille, Malad. des Negres, 8, &c. ; Ibid, des 
Pays Chauds, 4; J. Wilson, 66-7; Boyle, Ed. J. viii. 173; Warren, 8; Dariste, 32; 
Osgood, 18; Good, ii. 168; Chisholm, ii. 264; Dalmas, 38; Bally, 327; Gillkrest, 279; 
Musgrave, Med. Ch. Tr. ix. 121 ; Imray, Ed. J. liii. 92 ; Chalmers, i. 22 ; Lining, 
ii. 407 ; Townsend, 377 ; Hosack, ii. 29 ; Ckervin, translation of Wilson on Fever of 
Gibraltar, 9; Sir J. Fellowes, 417; Hunter, 13; Ferguson, Med. Ch. Tr. viii. 142; 
Evans, 45 ; Davy, Notes to Blair, 52 ; Drake, 712-3. 

2 Report of Sickness in Mediterranean Station, 65. 

3 Nepple, Fievre Interm. 135. 

4 Emlen, N. A. Journ. v. 328; Carey, 7. 

5 Lining, op. cit. ii. 410. 6 Rochoux, 110; Pariset, 475. 

7 Williamson, Med. and Miscel. Obs. on West Indies, i. 210, 211; Pinckard, Notes 
on the West Indies, ii. 485; R. Jackson, Sketches, 9, 10, 11. 

8 Jacquot, Des F. a Quinquina, 19 ; Haspel, Maladies de l'Algerie, i. 67. 

9 A Treatise on the Plague and Pestilential Fever, 10, 11. Lond. 1751. 
J0 Ibid. 



AUTUMNAL FEVERS. 137 

try, Europe, and elsewhere, the same observation has been made, so 
far as regards ordinary fevers. 1 To this it may be added that, in 
localities where fevers have been driven away through the opera- 
tion of judicious hygienic measures, the effect was not attended 
with a diminution of atmospheric temperature; that some forms of 
autumnal periodic fevers are restricted to very circumscribed locali- 
ties, where the heat is no greater than in the immediate vicinity ; and 
that when it breaks out in a ship and spares others close by, or 
when it ceases in a vessel on the latter's shifting its position, we 
cannot presume that a difference of temperature can have had any- 
thing to do with the difference of the results observed. 

The following statements, derived - from a report recently pub- 
lished by Mr. Lorin Blodget, who has charge of the meteorological 
department of the Smithsonian Institution at Washington, may be 
appropriately placed here. 2 

Few summers in this country have been characterized by greater 
heat than the one we have just passed through. The excess has 
prevailed from New Hampshire to Savannah in Georgia. The first 
general high temperatures of the season occurred on the 3d to the 
5th of June, extending from Montreal to Florida, but sparing the 
west generally. At the south, its maximum, from Chapel Hill, 1ST. 
C, to Savannah, Ga., was 92°; and at the north, from Montreal to 
New York, 83°. From the 14th to the 18th, the heat was excessive 
and general. It commenced at the extreme west on the 12th and 
13th, and did not extend beyond Camden, S. C. It rose from 90° 
to 94° in Ohio, Kentucky, and westward in the same latitudes. 
From the 20th to the 23d, there was another general excess of tem- 
perature — less than the preceding in the extreme north, and with a 
considerable fall there on the 22d ; but quite unusual and long-con- 
tinued at almost every other part of the country. The maxima 
varied from the 20th to the 23d, and ranged from 90° to 97°. The 
maximum of 95°, was probably general from New York to Savan- 
nah on the 23d. Lastly, a most extraordinary extreme of heat 
occurred on the 29th and 30th. The extreme was central in the 

1 Leblond, 184; Pugnet, 342; Rush, iv. 155; Deveze, 117; Emlen, loc. cit. 329; 
Chisholm, i. 294 ; Nott, Charleston Journ. iii. 5 ; Fenner, N. 0. Journ. v. 203 ; Cald- 
well, Repos. vii. 149, 153; Palloni, 33. 

2 On the Climatic Conditions of the Summer of 1853, most directly affecting its 
sanatory character. — New York Journal of Med. Not. 1853, p. 313, &c. 



138 PNEUMONIA AND 

latitude of Washington, and was limited at Savannah, on the south, 
and Burlington, Vt., on the north. It attained 96° to 98° in Ten- 
nessee, Kentucky, and southern Ohio, and 77.5° to 102° at Wash- 
ington, and eastern Yirginia, and North Carolina. This is without 
any parallel in the records of temperature at Washington, and is 
several degrees above any recorded temperature at New Orleans, 
Mobile, and Savannah. 

The temperature of July was also high, and slightly above the 
normal mean in most parts of the United States. The excessive 
heat of the last days of June was prolonged through the 1st and 2d 
of July at 94° in Yirginia, at the south, and the range was generally 
high in this city and south, where it was again at 92° to 84°. The 
temperature was at or above 90° after the middle of the month only 
in the central part of Georgia and Alabama, and west in the lati- 
tude of Washington to Texas, for two or three days about the 20th, 
and again about the close of the month. 

In August, a period of general excessive heat occurred, begin- 
ning, as usual, at the west, and reaching 90° in several places on 
the 7th and 8th. The maxima in Illinois and the adjacent States 
were 70° to 90° from the 8th to the 13th ; in Ohio and Kentucky, 
nearly the same ; and passing eastward a little later through Penn- 
sylvania, the district of greatest excess was central at New York, 
from the 12th to the 14th. The temperature at one place south 
reached 90°. Later in the month, from the 25th to the 31st, the 
heat was unusually great in the south-west, Texas, the Cherokee 
Territory, and Mississippi, with an extraordinary reverse in Iowa 
and the adjoining States. 

Indeed, the summer of 1853 has been remarkable for its climatic 
conditions, and the extreme of temperature was much more strik- 
ing than usual. Yet, though epidemics of yellow fever, which re- 
quire a continuance of high temperature, prevailed in more places 
than- has been the case in this country for the last thirty years, 
many other places that have suffered from the disease on former 
occasions, as Savannah, Baltimore, and New York, for example, 
and where the temperature was unusually high, and even exceeded 
that of Philadelphia, escaped. 

In the latter city, too, though the mean temperature of the three 
summer months was 76.76, or nearly four above the common 
average, such a heat could not be considered as alone the cause of 
the disease from which we suffered ; for it has been exceeded, ac- 



AUTUMNAL FEVEES. 139 

cording to the records of the last sixty -four years, on two occasions 
— in 1798, when the fever prevailed, and in 1838, when the city 
was entirely free from it. It must be added that, notwithstanding 
the unusual heat of the season, we do not find that ordinary au- 
tumnal fevers were anywhere more rife, or that they extended over 
a wider expanse of country than usual; indeed, many localities 
have remained healthier than in cooler seasons. 

Heat, in a word, may be, and is, to a certain extent, requisite to 
promote the formation of other agencies ; it is doubtless essential 
to farther the evolution of the poison which gives rise to the disease, 
as everything connected with the appearance of the latter proves — 
its production in hot weather ; its absence in cold, and its disap- 
pearance on the accession of frost ; — heat may act, besides, as an 
exciting cause ; but alone it cannot occasion the peculiar form of 
fever under consideration. It requires materials to act upon, and 
from which, aided by other influences, it may extricate an efficient 
cause. That high and long-continued heat may, and does often, by 
its action on individuals unaccustomed to its effects, produce fever, 
is doubtless true, and perfectly well known to all physicians ac- 
quainted with the complaints of hot climates ; but the disease thus 
produced is different from true malarial fevers. More frequently it 
gives rise to other groups of morbid phenomena more or less 
distressing, violent, and dangerous — cerebral inflammations, or con- 
gestions, visceral inflammations, inflammatory angiotenic fevers; 
but these phenomena are in no way analogous to those character- 
izing the regular and specific pyrexiae under consideration. 

Fevers are not the effects of humidity alone. — Neither can we jus- 
tifiably attribute the effects in question to excess of visible moisture, 
either of the soil or of the atmosphere, whether produced by rain, 
or local or accidental causes; or to a high dew-point, or to fogs 
and dews alone, without the co-operation of some other and more 
efficient morbific agent. This view of the etiology of autumnal 
fevers has been advocated by respectable authorities, at home and 
abroad. Dr. Bell, of this city, informs us that he long had doubts 
as to the existence or agency of miasma, founded principally on 
the circumstance that fevers that are usually treated as endemical, 
not unfrequently become epidemical, and that this extension of 
such diseases is not pretended to be explained by an extrication of 
more miasma than usual, but by great irregularities in the seasons, 



140 PNEUMONIA AND 

and abnormal vicissitudes in the weather. The perusal of Giannini 
on Fevers, gave him additional reasons for distrusting the fashion- 
able theory — a result which must appear strange to any one who 
has seriously examined the work. But when he became acquainted 
with the valuable experiments and observations of Dr. Wells on 
Dew, and " discovered that all the pretended laws of miasm were, 
in fact, the phenomena of deAV, which latter we could accurately 
notice, while the separate existence of the former, or its independent 
action, were never demonstrated," he could not hesitate to abandon 
his belief in a doctrine not supported by fair induction from ob- 
served facts ; ] thus, let it be remarked, arriving, from the same data, 
at conclusions yery different from those which Dr. Wells reached ; 
for that distinguished physician never dreamed of denying the 
existence and morbific effects of miasm. 

The opinion of the main agency of humidity in the production 
of fever was also warmly supported in England by Fordyce. By 
this distinguished writer, whose Dissertations on Fever are among 
the most valuable works on the subject in our language, it was ad- 
mitted that if water is applied in a mass, " that is to say, if a man 
immerses the whole, or any part of his body in water, of the tem- 
perature of the atmosphere, in which he remains some time ; or if 
he throws water of such heat into his stomach," he is not found to 
be more frequently afterwards affected with fever than other indi- 
viduals not so exposed ; but if the air has particles of water floating 
in it, thus constituting mist or fog, or otherwise rendering it moist, 
and a man has continued for some time in such an air, fever very 
frequently follows. Moisture, therefore, must be the cause of fever. 
"Some," he remarks, " have contended that the application of water 
suspended in the atmosphere in the form of moisture, does not pro- 
duce fever. If those who hold this doctrine " were to live a year or 
two in Batavia, they would be convinced, by fatal experience, that 
men living in a moist atmosphere are more frequently affected with 
fever than a dry one." "Men, wearing any moist covering, have been 
more frequently affected with fever than those who have worn 
clothes not moistened with water." Some may escape ; but that is 
no proof of the harmlessness of such exposure ; and " the many ob- 
servations of men being immediately seized with fever, as well as 
other diseases, after being exposed to moisture, more frequently 

1 Bell on Miasm, 277. 



AUTUMNAL FEVERS. 141 

than those who have worn clothes free from all moisture (the other 
circumstances being the same), which have been both recorded in 
the annals of medicine, and have come under the author's inspec- 
tion, give as full evidence that moist clothes are capable of producing 
fever as any that can be generally procured with regard to the 
causes of diseases." 

"Moisture in the air," Dr. Fordyce continues, "or of the covering 
of the body, produces more fevers the warmer the atmosphere. But 
moisture produces fever in all temperatures. The Dutch have 
endeavoured to make the country of Batavia resemble Holland in 
the immense number of its canals. The consequent moisture of 
the atmosphere is very great in both places ; but, although fevers 
therefore frequently occur in Holland, they bear no comparison in 
number to those which happen in Batavia, where the fatality (owing 
to the moisture and heat of the climate) is so great that it is won- 
derful any person should ever approach that settlement, but from 
the absolute impossibility of otherwise obtaining water or food." 

Fordyce was well aware that " when the air is moist, in conse- 
quence of water evaporating from a marshy country, or from canals 
in which the water is stagnating, or moving with a very slow motion, 
fevers more frequently arise than when the moisture proceeds from 
the sea, large lakes, or rivers confined within their banks, and run- 
ning with a considerable degree of rapidity." But this, according 
to him, is no argument against the correctness of his views ; for 
instances may be cited in which the disease occurred in situations 
where the decomposition of animal and vegetable substances, such 
as occurs in marshes, could not be suspected. Thus, in the war 
which took place in Flanders in the years 1710 and 1711, "an 
army encamped upon a pure sand, in which water was found in 
digging less than a foot deep, and occasioned a great moisture in 
the air, exhibited in a few days numbers of fevers, although the 
army was perfectly healthy before, and no more fevers were pro- 
duced on shifting their ground. There are a vast many other 
instances of the same thing having taken place. Besides, fever has 
often arisen immediately in persons sitting in rooms the floors of 
which had just been moistened with pure water. Although, there- 
fore, substances arising from putrefying animal or vegetable matters, 
in marshes, or other stagnant waters, render the vapour arising from 
them the more dangerous ; yet it does not follow from thence that 
the particles of the water forming the moisture of the atmosphere, 



142 PNEUMONIA AND 

may not of themselves be the cause of the disease." 1 In his Fourth 
Dissertation, Dr. Fordyce reverts to the same views, and says: 
"These diseases have been produced in countries where the water 
was found at only a foot or two under the surface of the earth, 
whence the moisture has arisen and contaminated the air so as to 
occasion these diseases, while the soil has been perfectly dry, and 
there has not been the least appearance of putrefaction, the country 
being clear from woods. In this case it could be nothing but the 
moisture that produced the disease. One instance of this occurs in 
the encampment of the English army in the war about the year 
1745, in a sandy plain in Flanders. Another in a region of Peru, 
where water is everywhere to be found at about seventeen inches 
below the surface of the earth, though the country itself is barren 
for the want of water, and uninhabitable from the number of dysen- 
teries and semi-tertians which take place in it." 2 

That fevers frequently occur during rainy seasons, and are, in- 
deed, ordinarily encountered in damp localities, where rain is com- 
mon and falls abundantly ; where the soil, previously dry, has been 
rendered wet by some of the causes referred to, rain, freshets, over- 
flows, &c.; or where the dew-point is high, and vesicular humid- 
ity generally or often noticed, or considerable at the time ; that 
they often make their appearances at the first set in of the rains, 
the country prior to this having been dry and healthy ; and that 
hence a certain degree of humidity appears to be necessary to the 
development of the disease — the ivetting, in contradistinction to the 
drying process, proving injurious to health by exciting the fevers in 
question — are facts which no one need be told. It is true, also, that 
in many instances, if not in all, long-continued and thorough terres- 
trial humidity, or saturation of the soil, has been found to precede 
epidemic manifestations of yellow and some other forms of malarial 
fevers; and, on the other hand, that a complete absence of such 
humidity, a thorough desiccation of the soil to a great depth, as well 
as an excessive dryness of the atmosphere, are inimical to the pro- 
duction and continued prevalence of those diseases. Facts to that 
effect have been observed and recorded in this country, in South 
America, in the West Indies, in Africa, Europe, and Asia. They 
are true as regards both ordinary autumnal or periodic fevers, and 
malignant yellow fever. The humidity of the West Indies, of most 

1 Five Dissertations on Fever, i. 76, 79. Am. ed. 2 Ibid. Am. ed. 351. 



AUTUMNAL FEVEKS. 143 

parts of our Southern States and of the coast of Africa, is prover- 
bial ; and we know, not only that these are all fever regions, but 
that the outbreak of the disease coincides often with a wet season, 
and with the manifestation of increased moisture. 

The following remarks of Lind, relative to the African coast, will 
apply to many other places : " The large rivers in the dry season 
being confined within narrow bounds, leave a great part of their 
channels uncovered, which, having their moisture totally exhaled, 
become a solid hard crust ; no sooner do the rains fall than this long- 
parched crust of earth and clay gradually softens, and the ground, 
which before had not the least smell, begins to emit a stench, which 
in four or five weeks becomes exceedingly noisome. At this time, 
the sickness is generally most violent." 1 

In tropical regions, the sickly or fever season corresponds with 
that of the rains. In the French colonies, it is denominated liiver- 
nage. The latter is the period in which the sun heats the portion 
of the zodiac situated on the side of the equinoxial line where the 
rains prevail. The hivernage is consequently in reality the summer 
of such sections of tropical regions where it is observed. When 
the sun crosses the line, the rainy season necessarily changes side ; 
and with the accession of wet weather we have the advent of fever. 2 

The connection o£ humidity with fever — the necessity of the 
former for the production of the latter — is exemplified by the oc- 
currences at Tampico in 1836. The rains commence there in July, 
and are followed by intense heat. This is the period of yellow 
fever. In the above-mentioned year the rainy season commenced 
two months later than usual, and there was a corresponding delay 
in the appearance of the disease. 3 

In Bengal, the rainy season commences in June and continues 
until October ; the remainder of the year is healthy and pleasant. 
During the rains, the rich and fertile country is almost quite covered 
by the overflowing of the Ganges, and converted, as it were, into a 
large pool of water. Diseases rage among the Europeans in the- 
months of July, August, September, and October, consequently 
during the rainy or wet season. 4 

1 Hot Climates, 54. 

2 Becquerel, Des Climats et de l'Influence qu' exercent les Sols Boise's, &c. 124. 

3 Goupilleau, Bulletin de l'Acad. i. 456 ; Ibid. iii. 306. 

4 Lind, Hot Climates, 91 ; Shannon, Practical Obs., &c. on Diseases of Hot Climates, 
74 ; J. Johnson on Tropical Climates, 59. 



144 PNEUMONIA AND 

That the deleterious influence of the atmosphere is aggravated 
by an undue degree of moisture, has been found on more occasions 
than one. The following instance is derived from Dr. Home's Dis- 
sertation on Remittent Fever. This intelligent physician, who 
served in Flanders during Marlborough's campaign, and was sur- 
geon to Colonel Cope's dragoons, observed that while the cavalry 
were cantoned, in 1748, in the unhealthy ground about Bois-le-Duc, 
the number of the sick corresponded with the dampness of their 
situation and of the air. To settle the point, he procured a good 
hygrometer, by which he carefully measured, daily, the degree of 
moisture or dryness in the air ; and, upon comparing his tables with 
the register kept of the sick, he found that the progress of the dis- 
ease kept pace, as far, he says, as anything of the kind can do, to 
the humidity of the air. 1 It is proper to remark that the observa- 
tions of Dr. Home on this subject were in the malarial districts of 
the country, and that the greater degrees of moisture, which he 
found to increase the disease, occurred in the vicinity of marshes. 2 

But experience has shown that this is far from being always the 
case. Indeed, we find that the reverse often occurs, or, at least, 
that humidity, whether atmospheric or terrestrial — whether pro- 
duced by one or other of the sources mentioned, is not, alone and 
per se, sufficient to produce the effect in question. Fevers appear 
in seasons and times of dryness, when the soil, on the surface at 
least, is parched for want of rain; when there are no fogs, and little 
dew. On the other hand, they fail to show themselves under cir- 
cumstances of an opposite character, and are often arrested in their 
epidemic course by the very means that are supposed to be by 
themselves, and without concurrent aid from other conditions of 

1 Dissert. 14; Ibid. Med. Facts and Observations, 61, 62; Lind on Seamen, 72. 

2 " From the 29th, 0. S., of June, to the 12th, 0. S., of July, we had not one man 
taken bad. During this time, the air was never very moist, though not so dry as 
what it used to be in my tent during the day-time in camp. So that, taking day and 
night together, the moisture of my room surpassed the moisture of my tent. On the 
evening of the 12th, my hydrometer fell very low, and the air was considerably 
damper than ever I had yet seen it in quarters. From this very night this present 
distemper began in our regiment ; for that night three were seized with it. It con- 
tinued for eight days damp weather ; and the number of those taken bad every day 
increased. The ten days that followed were drier ; during which time not so many 
were taken bad as before. Two days then followed of damp weather ; in which time 
our number increased. Then, on the weather turning drier, the disease abated. 
The same equal pace did this disease keep afterwards with the moisture of the air." 
(Pp. 61, 62.) 



AUTUMNAL FEVERS. 145 

atmosphere, instrumental in their production. Major Tullock, in his 
excellent Keport on the sickness of the British troops in the West 
Indies, after remarking that the inference of the connection as 
cause and effect between humidity and disease, derives plausibility 
from various facts in the history of tropical fevers, especially their 
great prevalence along the sea-coast, at the outlet of rivers, and in 
the vicinity of swampy level ground, adds that this hypothesis 
seems at variance with the facts noticed : " For, if the mortality of 
the troops depended materially on the influence of moisture, we 
might expect it to attain its maximum in those stations where the 
fall of rain was the greatest ; whereas, the average mortality of the 
troops in Jamaica is at least double that which prevails among 
those in British Guiana, though the quantity of rain which falls 
in that island is little more than half as great ; and in the preced- 
ing pages there are adduced many instances in which epidemic 
fever has broken out, and raged with great violence, at a period 
when no rain had fallen for several months ; nay, in some stations 
a dry, in others a wet season, is looked on as the most unhealthy 
— an anomaly not likely to occur if excess of moisture was uni- 
formly an essential cause of insalubrity." 1 

Madeira, the Canary Islands — not far from the coast of Africa — 
the islands of St. Antonio and St. Nicholas, are healthy, though 
humid ; while Fernando Po, Princes, and St. Thomas islands, not far 
from these, are, like Senegal, unhealthy. Barbadoes, St. Christopher, 
and Bermuda, though at no great distance from fever countries, 
are healthy ; and, while St. Lucia is unhealthy to a degree, Pigeon 
Island, which is not less humid than the opposite coast, is free from 
febrile diseases. Dr. Eollo calls attention to the circumstance, that 
some of the troops that landed in 1778 at St. Lucia, and were en- 
camped at the Yigie, were there exposed to fatigue, constant rain, 
and changes from heat to cold, and yet they were not sickly. They 
were thence removed to the windward of the Carenage, where, to 
the former causes, were added marshy exhalations. They then 
became subject to fevers, from which they were once more freed by 
resuming their former position. 2 

Heberden many years since remarked that the air is often fully 
saturated with moisture, and could not be more filled by the vapour 
arising from a chamber covered with water; and yet, he adds, 

1 P. 101. 2 Diseases of the Army at St. Lucia, 07. 

10 



146 PNEUMONIA AND 

" neither is any epidemical distemper produced by it, nor are those 
remarkably aggravated with which the sick happen at the time to 
be afflicted. The air from rivers and from the sea, is probably 
more replenished with vapours than inland countries cleared of their 
woods, yet they are generally healthier." 1 Dr. Ferguson has shown, 
from undeniable facts, that mere humidity from fresh water is not 
productive of fever. 2 He remarks that water kept in stone tanks, 
or anywhere, so that it can be preserved in bulk without being 
absorbed by the surrounding soil, is not productive of disease. 
One of the healthiest quarters in the West Indies, according to that 
able physician, is that of the field officers on Berkshire Hill, St. 
Vincent, the bedroom of which is placed immediately over a deep 
stone reservoir of water. A block-house in Demerara, reported to 
be one of the healthiest quarters there, is similarly situated; and it 
is known to all that the fresh water laid in for a ship's crew, how- 
ever much in contact with their sleeping-places, produces nothing 
like marsh fever amongst them. Similar statements relative to the 
innocuousness of fresh water will be found in the works of Mc- 
Lean, 3 Lempriere, 4 Bancroft, 5 Belcher, 6 K. Jackson, 7 Pugnet, 8 Dick- 
son, 9 Drake, and others. 10 

In speaking of Fort Augusta and Port Eoyal, Jamaica, Dr. Hun- 
ter remarks that simple moisture is harmless, " at least as far as 
relates to the production of fevers, of which the two last-mentioned 
places may be given as examples, for they are nearly surrounded 
with water on all sides. It is true," he adds, " the air is perfectly 
clear, yet it must be loaded with moisture in consequence of the 
great heat of the sun acting upon the water. But the vapour arising 
from water is harmless, even when rendered more an object of our 
senses, by being condensed into fogs and clouds. The parish of 
St. Thomas in the Vale, is every night covered with a thick fog, 

1 Med. Tr. by the College of Physicians of London, ii. 523-4. 

2 Med. Ch. Tr. viii. 129. 

3 An Inquiry into the Nature and Causes of the great Mortality among the Troops 
at St. Domingo. London, 1797 ; 24-25. 

4 Practical Observations on the Diseases of the Army in Jamaica in 1792-1797, 
ii. 5, 6. 

5 An Essay on the Disease called Yellow Fever, 243. 

6 Edinb. Med. and Surg. Journal, xxiii. 47. 

7 A Sketch of the Hist, and Cure of Febrile Diseases, 11. 
, 8 Memoire sur les Fievres de Mauvais Caractere, 342-3. 

9 New York Med. Journal, Sept. 1841 ; 175. 

10 Diseases of the Valley of the Mississippi, &c. i. 610, 711. 



AUTUMNAL FEVERS. 147 

owing to the rivers which pass through it sending forth vapours, 
which in daytime are perfectly transparent, but towards evening, by 
the cool air coming from the neighbouring mountains, they are con- 
densed, and remain visible till next day's sun disperses them, with- 
out, however, being at all unwholesome." 1 Other facts lead to the 
same conclusions. In an excellent report on the epidemics of 
France during the years 1841-1846, by M. Graultier de Claubry, 
mention is made of a small commune — St. Jean de Losne — situate 
in a valley of the Department of Cote d'Or, along the banks of the 
Saone, and near the canal which unites this river to the Ehine. 
This commune, from its position, is much exposed to fogs, and 
remarkable for its great humidity. Nevertheless, it is usually free 
from periodic diseases. In 1843, however, it was visited by an 
epidemic of intermittent fever, which was easily traced to other 
causes, and could not be due to the hygrometrical condition of the 
atmosphere, which at other periods failed to produce that effect. 2 

M. Madier, who practised at St. Andeol, a small town in France, 
says of fogs : " We are exposed to them at all times, especially 
during the spring and autumn. The fogs, which show themselves 
after a few days of dry weather, and when a light rain has fallen 
the day before, have a very strong earthy smell ; but when they 
appear after a rain which has penetrated the soil to the depth of 
a few inches, they do not emit any odour. I have not noticed that 
fogs, in whatever season they may prevail, have exercised an in- 
jurious effect on individuals in health, and given rise to any par- 
ticular disease." 3 Let it be remarked that the country around this 
town is not marshy. 

If fogs and heavy dews were of themselves, and without the 
concurrent aid of other and more efficient agencies, the active in- 
struments in the production of fevers, there would be no difference 
whence they came. The effect would be the same whether they 
arose in elevated and mountainous regions or in valleys and plains. 
Fever would be noticed in all moist and foggy countries — in the 
Western Highlands or Cornwall, more than in Norfolkshire or 
Lincolnshire, as also in every place where dews are heavy ; and, on 
the other hand, localities, where fogs and dews are not observed, 

1 Obs. on the Dis. of the Array in Jamaica, 13, 14. 

2 Mem. de l'Acad. de Medecine, xiv. 120. 

3 Mem. sur la Topographia Med. du Bourg St. Andeol ; Mem. de la Soc. Royale, 
v. 78. 



148 PNEUMONIA AND 

would not be the seat of febrile complaints. Now, we know that 
this is not the case. These atmospheric conditions are not the pro- 
ducts of malarial localities only. Dew, for example, will be abund- 
ant wherever vegetation is rich, and may, like fogs, be seen as well 
on hill-tops, where no malaria exists, as on low ground, where it is 
copiously evolved ; or both may prevail in a place during healthy 
seasons, and be less or not more observed during sickly ones. This 
is no fancy on my part ; for if the reader inquires into the matter, 
he will easily find that everywhere localities present themselves, 
which, like those referred to by Dr. Hunter, are subject to fogs and 
heavy dews, and yet notwithstanding are healthy ; while, in nume- 
rous instances, fever has broken out under meteorological condi- 
tions which forbid the possibility of its being referred to such 
agencies. Thus, the banks of some streams in this country, and 
not a few at a short distance from our city, though the seat of heavy 
fogs and dews, are seldom visited by autumnal fevers, not as fre- 
quently so, certainly, as other kindred localities differently circum- 
stanced. Such is the case with the upper part of the Wissahicon, 
where, notwithstanding the fogs and dew observed in certain seasons, 
malarial diseases are not known. The city of Charleston furnishes 
us with an interesting illustration of the want of connection between 
the degree of evaporation and condensation and the production of 
malarial fevers. During July, August, and September, of the fever 
year of 1849, the evaporation was much higher than it was in the 
non-malarial years of a series extending from 1845 to 1852 inclu- 
sive, amounting to 1,485. But in 1852, which was highly malarial, 
the evaporation did'not exceed 1,454, while in 1850 it was 1,418; 
a difference too trifling to justify us in investing it with importance. 
As to the degree of condensation, it amounted, in 1849, to 173 ; 
contrasting with what took place during the two non-malarial years 
of 1850 and 1851, when it was 111 and 81. On the other hand, the 
sickly year of 1852 gives us an amount of only 83 ; only two de- 
grees higher than 1850, and 28 lower than 1851. 1 

Were fogs and mists the efficient and active cause of fever, we 
might expect to find the disease prevailing in other seasons besides 
that in which it almost exclusively shows itself; and yet in regions 
visited by it, the humidity produced by, or connected with, the 
thaws and fogs of the spring, and which, in many instances, is as 

1 Hume, Charleston Journal, viii. 67. 



AUTUMNAL FEVERS. 149 

considerable as, if not even more so than, at the sickly period, 
proves perfectly innocuous, heat being often at the time considerable. 

The waters of the Gulf Stream flow with great rapidity near the 
banks of Newfoundland, bringing with them a temperature of from 
six to twelve degrees warmer than that of the superincumbent 
atmosphere, and of the sea itself in that part of the ocean according 
to the season of the year. This superior heat in the Gulf Stream, 
as is remarked by Dr. Bancroft, aided by its motion, produces 
a copious evaporation of aqueous particles from the surface, which 
are immediately condensed by the coldness of the air, so as to pro- 
duce those fogs which, during summer, prevail on the Newfound- 
land station, to a greater excess, probably, than in any other part 
of the globe. 1 Mr. Cassini, as quoted by Bancroft, states, in the 
account he has given of his voyage to Newfoundland, that "it is 
difficult for one who has never been there, to form an idea of the 
life the fishermen lead at the Great Bank. It must be no less power- 
ful a motive than the thirst after gain which can prevail upon these 
poor wretches to spend six months between the sky and water, in 
a climate where they are almost always excluded from the sight 
of the sun, and constantly breathing so thick a fog that they can 
hardly see from one end of the ship to the other." Yet, notwith- 
standing, the men so employed are remarkably healthy and free 
from fever. "The island," says Major Tullock, "has been long 
noted for the frequent and dense fogs which prevail along its banks, 
and often continue during a great part of the summer. None of 
these agencies, however, seem to operate prejudicially on the health 
of the inhabitants, among whom the mortality is on a lower scale 
than on any portion of the American continent. 2 

When, with these facts before us, we bear in mind that fogs, 
vapours, and dews are only injurious — so far as the production of 
fever is concerned — in localities that are marshy or swampy, or 
that possess a soil composed of materials capable of furnishing ma- 
larial exhalations — in other words, in situations where fevers often 
prevail without the aid of such hygrometrical phenomena, or in 
those open to the free admission and active agency of winds pass- 
ing, before reaching them, over surfaces of that kind, as is the case 
with the smokes of the African coast ; we cannot resist the conclu- 

1 Essay on Yellow Fever, 189, note. 

2 Report on Sickness of Troops in British America, 35-6 ; Lind on Hot CI. 30-1. 



150 PNEUMONIA AND 

sion that, when such fogs, vapours, and dews exist in sickly districts, 
they act merely as. predisposing, or exciting causes, and as vehicles 
of the poisonous agent, and should not be regarded in the light of 
the efficient cause of the disease. 

In addition, it may be remarked that, in the large majority of 
places subject to fever, the disease makes its appearance not at the 
height of the rainy season, when the moisture of the atmosphere 
must be greatest, but at the commencement and close of it, when 
the soil is moistened without being drenched, or after it has become 
somewhat dried. Nor should we forget that vessels at a short distance 
from the coast remain healthy, and take the fever by approaching 
near, though the humidity in the former situation was, if anything, 
greater than in the latter ; that some forms of fever are more pre- 
valent and assume a more malignant character during dry weather, 
and even during droughts ; that in yellow fever regions, seasons 
marked by much rain have often proved the healthiest ; that, in 
some localities, in proportion as the humidity of the climate has 
lessened, fever manifestations have increased ; and that the disease 
is sometimes checked by heavy rains. 

We have here, therefore, the reverse of what was said above of 
the injurious effects of the wetting process ; for while the latter, by 
its operations on localities more or less dry and parched, gives rise 
to fever, the same disease is often an attendant on, and a result of, 
the drying process ; — not making its appearance until the surface, 
after having been covered or saturated with water, is becoming, 
through the evaporating agency of heat, to a considerable extent de- 
siccated; excess of dryness and excess of moisture being alike inim- 
ical to the production of the febrile cause. In neither of these two 
processes can we admit, therefore, a monopoly in regard to the 
power of giving rise to that dire effect ; and the very fact of two 
influences of such antagonistic characters exercising that power, 
under opposite local circumstances, must naturally lead to the infer- 
ence that the result in question is obtained, not in virtue of any 
morbific influence dependent on a wetting or drying operation, 
abstractly considered, but on the change they each occasion in 
the soil of the locality thereby rendered sickly, or in the organic 
materials placed on its surface ; — drying them in the one case when 
too wet, and moistening them in the other when too dry. If we 
admit this, we must admit also that as the effect is obtained in none 
but localities of the peculiar kind already mentioned, and as neither 



AUTUMNAL FEVERS. 151 

the wetting nor the drying process exercises any morbific influence 
of the kind alluded to, under different conditions of soil or local- 
ity, that effect, when produced, must be due, not to a little more or 
a little less dryness, either of which, as we have seen, may exist 
in salubrious situations, but to the extrication from that soil or the 
materials scattered over it, of some peculiar agent which, operates 
as a poison on individuals exposed to its influence. 

But let this be as it may for the present, with the above facts 
before us, we can better appreciate the pertinency of Major Tul- 
lock's remarks, already referred to, that " in some stations a dry, in 
others a wet season is looked on as the most unhealthy." Long- 
before Major Tullock's days, Dazille had recorded the same ob- 
servation in a passage strangely mistranslated by Dr. Eush, and 
handed down, in all its imperfections, by several successive writers. 
" It is during dry weather that diseases prevail at Cayenne ; on the 
contrary, it is during the rainy season that they spread in St. Do- 
mingo. The reason of this difference is that at Cayenne, during 
the period of rains, the marshes contain a sufficient quantity of 
water to be preserved from corruption, and to be renewed gradually 
by the flow and ebb of the sea. When once the rainy season is over, 
the waters become stagnant and in a state of corruption, and occa- 
sion by their putrefaction that of a large quantity of insects and 
animalcules, the effluvia from which are exhaled in the atmosphere, 
thence pass, through means of respiration, into the lungs, and carry 
into the humours the germ of the diseases which afflict the inhabitants 
of the vicinity." 1 An accurate observer of modern times states, in 
reference to the malarial fevers of Europe : " The most unhealthy 
years, in humid districts, are those noted for excessive heat, or great 
and long-continued dryness ; while in dry localities, the most sickly 
are the rainy years." 2 

The following facts illustrate the injurious effects of the drying 
process: — 

In India, during the unwholesome season, as stated by Bishop 
Iieber, in the account of his journey through that country, all 
living things leave the pestiferous region, and man dare not venture 
abroad. " Yet, during the time of the heaviest rains, while the water 
falls in torrents, and the cloudy sky tends to prevent evaporation 
from the ground, the forest may be passed with tolerable safety. It 

1 Dazille, Maladies des Negres, 10. 2 Villerme, Annales d'Hygiene, xi. 347. 



152 PNEUMONIA AND 

is in the extreme heat, and immediately after the rains have ceased, 
in May, the latter end of August, and the early part of September, 
that it is most deadly." Of another pestiferous locality an intelligent 
writer remarks: "The different seasons of the year have consider- 
able influence upon the unhealthiness of Batavia. On this subject 
erroneous notions have been laid before the public. The rainy 
season, during the months of January, February, March, and April, 
has generally been represented as the most unhealthy. This is 
owing to an error in observation. During the rainy season, the 
rivers and canals are plentifully supplied with water, which flows 
through them with considerable rapidity ; most of the lower marshy 
situations are entirely inundated with water, by which the existing 
putrefaction is either very much checked or entirely prevented." In 
June, the marshes and canals begin to dry up, and with this the 
unhealthiness commences. In July and August, the dryness and 
exposure of the latter are still greater, and the disease is rife. "This 
is the season of death and destruction." In October, the dryness, 
etc., being more excessive, and the materials of decomposition being 
more thoroughly destroyed, the disease decreases and becomes less 
malignant. In November and December the effect is still greater. 1 
According to the observations made by M. Don, chief civil engi- 
neer at Algiers, as quoted by M. Becquerel, from the Annuaire 
Meteorologique de la France (1850), and embracing a period of ten 
years, from 1837 to 1847, rain in that country increases from 
August to December, and decreases from January to July; the 
maximum being in December (175.444 millimetres), and the mini- 
mum in July (0.150 millimetres). The dryness commences in May, 
and continues to the end of September, sometimes to October. 

The 1st quarter from 1st December to 28th February, 451.594 
" 2d " " 1st March to 31st May, 211.380 

" 3d " " 1st June to 31st August, 015.175 

" 4th " " 1st September to 30th November, 261.088 

From this, we perceive that one quarter is very wet, that an- 
other quarter is very dry, and that these are separated by two 
quarters differing but little from each other in respect to the 
amount of rain. 2 

1 Horsefield, An Account of a Voyage to Batavia in the Year 1800, Coxe's Med. 
Mus. v. 78. 

2 Becquerel, Des Climates, &c. 174, 175. 



AUTUMNAL FEVERS. 153 

Dr. Haspel, 1 whose observations were made in the province of 
Oran, divides the year into four periods. The first commences in 
March and ends in June. At this period but little rain falls. The 
second embraces July, August, and September. It is characterized 
by much dryness. The third period commences in October and 
ends during the course of December. Eain now commences, and 
falls in showers, whicb, with the torrents flowing from the Atlas, 
submerge the plains. The fourth period comprises the latter half 
of December, the whole of January and February, and the begin- 
ning of March. It is characterized by much rain, which sometimes 
commences at the close of November, and recurs at longer or 
shorter intervals till the close of the following April. 

Now, on referring to the highly interesting work just mentioned, 
and to others on the same subject, it will be found that at Algiers, 
as in other kindred climates, the spring months are healthy; while 
the dry and parching weather of July, August, and September is 
extremely unhealthy. Fevers then abound, assume the remittent 
type, and become often pseudo-continued, and malignant. In the 
third period, which, as we have seen, is wet, malarial fevers, though 
becoming more severe and complicated, lessen in frequency. Dur- 
ing the fourth and still wetter period they disappear nearly if not 
completely ; showing themselves only in individuals who have been 
attacked in the preceding summer or autumn. 

Of the years 1845 to 1852 inclusive, the last and 1849 were the 
only ones during which the yellow fever prevailed at Charleston. 
In 1852, the quantity of rain which fell during July amounted to 
6.95 inches; August furnished 4.21, and September 12.27; mak- 
ing a total of 23.43. In the year 1849, July gave 6.35, August 
5.16, and September 6.27; total 17.78. But while the quantity in 
the first of these two sickly seasons exceeded considerably several 
of the healthy years of the series, it was only 0.68 greater than 
the quantity in 1847, when no fever prevailed ; while the amount 
that year (22.75) and in 1845 (19.71) exceeded that in 1849 by 
several inches. So far as Charleston is concerned, therefore, though, 
as remarked by Dr. Hume, from whom these facts are derived, the 
yellow fever has never appeared in a non-pluvial season, showing that 
some degree of humidity is required ; yet the facts mentioned, and 
many others that could be gathered from Dr. Chalmers's account of 

1 Maladies tie l'Algerie, i. 28. 



154 PNEUMONIA AND 

the climate of South Carolina, pluvial seasons are not necessarily 
accompanied by fever. 1 In 1752, 27.45 inches fell during July, 
August, and September; and yet, notwithstanding, the season was 
healthy. 

In Louisiana, while some of the most humid and wet localities 
are little affected by intermittents, others, differently circumstanced 
in that respect, are highly subject to the disease. Such is the case 
in East Feliciana, and the parishes lying to the east of it. " These 
parishes consist of high lands, which constitute a portion of that 
bluff-formation of the south, and have an elevation of from one 
hundred to two hundred and fifty feet above the level of the Missis- 
sippi Eiver at that point. The lands are generally thin, and covered 
either with open forests of the long-leaf pine, or with those of oak, 
beech, and other trees, intermixed with a growth of loblolly pine, 
and other species." " In this region, the climate is obviously drier 
than in the low lands of the delta, as is shown by hygrometrical 
tables, as well as by the fact that here the Spanish moss is scarcely 
met with, while in the low lands it covers every tree, and the 
growth of this plant is a good hygrometrical index. Notwithstand- 
ing the favourable aspect of these regions, as respects health, the 
inhabitants are very subject to ague and fever." 

This connection of dryness with unhealthiness had not escaped 
the notice o^ Lord Bacon, who remarks : " The general opinion is, 
that years hot and moist are most pestilent ; upon the superficial 
ground that heat and moisture cause putrefaction. In England, it 
is found not true ; for many times there have been good plagues in 
dry years. "Whereas, the cause may be, for that drought, in the 
bodies of islanders habituated to moist airs, doth exasperate the 
humours and maketh them more apt to putrefy or inflame ; besides, 
it tainteth the waters commonly, and maketh them less wholesome. 
And again, in Barbary, the plagues break up in the summer when 
the weather is hot and dry." 3 

The fever which prevailed at Copenhagen, in 1652, and is de- 
scribed by Bartholin, began in autumn, after an unusually hot 
and dry summer. 4 In 1669, Ley den was visited by a like fever. 
The spring and beginning of summer were cold, but the remainder 

1 Hume on Causes of Yellow Fever, Charleston Journ. viii. 64. 

2 Carpenter, New Orleans Journ. iii. 429. 

3 Bacon, Nat. Hist. Cent. iv. Exper. 383. 

4 Hist. Anatomia, Rar. Cent. ii. hist. 56. 



AUTUMNAL FEVEES. 155 

of summer and the autumn were unusually hot, with little or no 
rain. 1 " It is remarkable," says Pringle, " that pestilential diseases 
have frequently occurred in dry and hot summers, and agreeably 
to this, I have observed that most sickly seasons in the field have 
been attended with the greatest heat and the least rain." 2 Hippoc- 
rates himself has left his testimony on this subject, for he mentions 
remittent fevers as having been common in summer and autumn, 
and most prevalent when wet springs with southerly winds were 
succeeded by hot and close summers. 3 

The example of Sicily is apposite. Light rains in autumn are 
there unhealthy, evidently from their moistening the earth, which 
previously had been dried effectually and to a great depth by the 
heat of summer, and thereby putting it in a state capable of evolving 
febrific effluvia. Whereas, nothing is as salutary as heavy rains 
about the middle of September, which not only mitigate the heat, 
but, by covering or saturating the earth, put a stop to the produc- 
tion of the cause of fever. 4 The country is penetrated in several 
directions by ridges of primitive hills of considerable height, and 
apparently a continuation of the Apennines. Between these are 
numerous watercourses, which are dry in summer, and occasionally 
filled by torrents in winter. They are denominated fiumari, by the 
natives, and are used as roads in the dry season. Many of them are 
extremely unhealthy in the latter part of summer and in autumn, 
and infected by malaria. Much of this unhealthiness, however, de- 
pends on the state of the season. A very dry season will, while 
parching the surface of the earth, put an obstacle to the production 
of the cause of fever, and render the country healthy. The same 
effect is produced by a very wet season, which, by saturating the 
earth and completely filling up the fiumari, and covering their 
sickly beds, puts a stop to the extrication of the febrific cause. 
Fever there is rife only at periods when the soil is partially satu- 
rated, and principally while the drying process is going on, or when, 
after having been parched and completely dried, it is moistened by 
moderate rains. In situations where, from peculiar local circum- 
stances, complete desiccation does not occur, and the ground is only 

1 Silvius cle la Boe Prax. Med. Append, tract, x. Oratio de affectus epidemic! 
Leidensis causis naturalibus dicta. Leyd. 1670. 12mo. 

2 Dis. of the Army, 81, part 2, chap. ii. 

3 Epidemics, lib. iii. Sect. 3. 

4 Irvine, Observ. upon Diseases of Sicily, 2. 



156 PNEUMONIA AND 

partly freed from water, as at Lentini, around which the country is 
marshy, with a considerable lake in the vicinity, or, among other 
places in the large fiumare which bounds Messina on the northern 
side, where the stream disappears in the gravel, and, percolating 
under the surface to the sea, fresh water is found at a foot depth, 
fever prevails every year, and at all seasons. 1 In Sardinia, too, 
fever rages from June to September. In some summers there is a 
want of rain for four or five months, and then it is that sickness 
exerts its utmost violence. 2 

Senegal is proverbial for the wide and extensive prevalence of 
periodic fevers. There, as in many other places, the country is 
healthy during the height of the rainy season, when the soil, like 
that of Egypt, is nearly all covered over with water, and the moist- 
ure of the atmosphere is necessarily considerable. During the 
drying process which succeeds to this condition of things, and com- 
mences about the middle of September, the soil gradually becomes 
uncovered, and soon adorned with the richest vegetation; while in 
its moist state, it remains for some time exposed to the influence of 
the burning sun. This is the period of fevers. These extend far 
and wide, and continue to prevail until, through the effects of heat 
and other agencies, the desiccation of the soil and the dryness of 
the atmosphere become complete. As soon as these results are 
obtained, the country once more becomes healthy. 3 

In several of the fluvial basins within the torrid zone, or on its 
margins, the rainy season is the period of health and the dry season 
that of disease. See what takes place in the district of Lower 
Egypt. There the dry season, when the Nile is low, and the coun- 
try is moistened solely \)y irrigation, is febriferous. In May and 
June the majestic river begins to rise, and the increase of the 
water, and consequently of the humidity of the soil, is hailed as the 
sign of approaching salubrity. 4 

1 Irvine, Observ. upon Diseases of Sicily, 3, 4, 5. 

2 Lind, 31. 3 Thevenot, op. cit. 21, 25, 48. 

4 Prosp. Alpines, De Morb. iEgypt, lib. i. cap. xiv. ; Craigie, Pract. i; 81 ; Volney, 
Voy. en Egypt, i. 213; Macculloeh on Malaria, 107; Sir James McGrigor, Sketches, 1. 

The researches of M. Villerme on the influence of marshes on the duration of life, ' 
have led to interesting conclusions, a summary of which may be appropriately placed 
here. In the eight most marshy departments of France (Ain, Charente Infcrieure, 
Gard, Gironde, Herault, Bouches du Rhone, Var, and Vendee), where epidemics of 



1 An, d'llyg. xi. 346, <fcc. 



AUTUMNAL FEVERS. 157 

We have seen that, in Bengal, the sickly is the rainy season, and 
that fevers are rife when the country is wet. It appears, how- 
ever, that the moisture mnst keep within certain "bounds, It is 
remarked that the more complete the inundation, the more healthy 
are the inhabitants, till the fall of the waters, in November and 
December, expose a number of miry and slimy marshes to the 
action of a still powerful sun, when those who are in their neigh- 
bourhood are sure to come in for a share of remittents and inter- 
mittents. 1 The same effects that are noticed in Bengalese, after the 
waters begin to fall, take place when the inundation has been con- 
siderable enough to cover the country. "When the rains are late 

periodic fever reign annually during two, three, or four months, the mortality among 
children under four years of age is much greater in August, September, and October, 
when fever prevails, than in January, February, and March; while the whole number 
of deaths among individuals, from four years old to one hundred, always attains its 
maximum in winter ; in other words, the influence of marshes on young children is 
such, supposing the eifect to be produced by one cause only, that in every thousand 
deaths of young children which take place in healthy districts, 1,546 occur in the 
aforesaid eight departments. The baneful influence of marshes in the above-men- 
tioned classes will appear still more striking, if we compare the mortality which 
occurs in paludal districts during the spring or the commencement of summer, wheu 
it is least, with that which occurs during August, September, and October, when it is 
largest ; for it will be found that for every death noted in the first period, we have in 
each of the three other mentioned months, according to the localities, two, three, four, 
sometimes five, and even six. In the aforesaid eight most marshy departments, the 
number of deaths occasioned by paludal exhalations, among very young children, is 
greater in September; while the mortality from the same cause among other indi- 
viduals, reaches its maximum in October. But although, as we have seen, the loss 
among children in those eight departments, considered together, is largest in Septem- 
ber, we find that, in the departments of Ain and la Vendee, the least southern of the 
series, and those in which the desiccation of the marshes is effected at a later period, 
the most fatal month is October. In the other departments, the period of that 
maximum is earlier in the ratio of their southerly situation, or in proportion to the 
earliness of the desiccation of the marshes. Indeed, the period at which these are 
dry, as well as that of the prevalence of the disease, and of the large mortality they 
occasion, advances in the south of our hemisphere, and is retarded in the north. 
When the march of the seasons advances, or is retarded ; when the drying up of the 
marshes is longer in being effected, or is accomplished with greater rapidity, the 
greater mortality they produce commences earlier or later, and continues in the 
autumn long after the hot weather, or ceases during the continuance of them. M. 
Villerme properly remarks that, as the maximum of the mortality among children in 
the marshy departments, and an increased mortality at other periods of life, constantly 
coincides with the period of desiccation, complete or partial, of the marshes, and not 
with that of the greatest heat, it follows that this effect must be ascribed more to 
that desiccation than to a high degree of temperature. 
1 Johnson on Tropical Climates, 43. 



158 PNEUMONIA AND 

in setting in, many people are suddenly cut off by the intense heat 
of the sun in June and July. But this is nothing compared to the 
havoc produced by a sudden and premature cessation of the rains, 
or Bursautty, as they are called. In this last case, an immense sur- 
face of slime and feculence is all at once exposed to the rays of a 
vertical sun." " The consequence is that the profuse exhalation of 
miasmata spreads pestilence in every direction." 1 

The air on the flat country which stretches along the eastern and 
northern coast of the island of Ceylon, is very dry and hot, during 
the south-west monsoon. Showers rarely occur there during the 
months of May and October. During the influence of this mon- 
soon, a hot land wind blows from the interior towards the eastern 
and northern coast of the island. This wind sets in about the 
middle of May, and blows, with but little intermission, till the end 
of August. In the other months of the year, there are regular sea 
and land breezes. While the land wind prevails, there are but 
rarely any sea breezes. The land wind often blows day and night 
for several weeks together, without much abatement ; it is always 
very dry and hot. Dr. Marshall, from whose work on the medical 
topography of the interior of that country I quote, states, in an- 
other page, that the above provinces are remarkable for insalubrity. 
The late king of Kandy sometimes took advantage of the pestilen- 
tial atmosphere of these districts, and transported thither the chiefs 
whom he considered disaffected to his interest. Few of the inhabi- 
tants escape the influence of the fever during the sickly season 
(pp. 6, 40). Dr. John Davy, in like manner, informs us, that fevers 
are rife in Ceylon during the season of dry weather (p. 75). Dr. 
Eollo mentions that the greater part of the regular remittents that 
prevailed at St. Lucia did so during the rains, when the pools and 
marshes were filled ; and that the most dangerous remittents ap- 
peared after their slimy surfaces became exposed and dry. 2 Dr. 
Copland states that the ditch around the ramparts of Geneva was 
once drained, and sickness prevailed in the vicinity, but disap- 
peared when it was again filled. 3 

Dr. W. Ferguson, whose name has become indissolubly connected 
with the subject of miasma, and who, though erring in pushing his 
notions as to the necessity of a dried surface farther than is war- 

1 Johnson on Tropical Climates, 44. 2 Op. cit. 69, 70. 

3 Diet. i. 703, Endemic Diseases. 



AUTUMNAL FEVEES. 159 

ranted by a survey of all the facts we possess, and ignoring the 
agency of the decomposition of organic substances (to say nothing 
of the inconsistency of denying in one place this agency, and in 
another referring the fever which occurred on board of the Eegalia, 
to the decomposition of a quantity of green wood stowed away in 
the hold of the vessel) — has added considerably to the stock of our 
knowledge in relation to the sources of that poison, and furnished 
many facts corroborating the views here advocated. The English 
army suffered much from endemic fever, under the remittent and 
intermittent forms, at Eosendaal and Oosterhout, in Holland, in 
1799. The summer had been hot and dry, and the soil, which was 
a level plain of sand, presented a perfectly dry surface. But on 
digging, it was universally found to be percolated with water to 
within a few inches of the surface. In 1799, the army, under the 
Duke of York, remained the whole autumn in the most pestiferous 
portion of that unhealthy country without suffering in any remark- 
able degree from fever. But the summer had been wet and cold. 
It rained constantly, and the whole country was nearly flooded with 
water. In 1810, the British army at Walcheren, on a soil as similar 
as possible, and not more pestiferous, suffered considerably from 
fever. But the soil, after having been thoroughly wet, had passed 
the ordeal of a hot and dry summer, by which the surface was 
partially desiccated. In Portugal and Spain, during the campaign 
of 1809, Dr. Ferguson found the hilly ravines that had lately been 
watercourses, but were now dried up by a continuance of several 
weeks of very hot weather, to be very unhealthy. The same results 
obtained during the retreat into the plains of Estremadura, along 
the course of the Guadiana Eiver (after the battle of Talavera). 
The country, which we may presume had been wet, was then arid 
and dry. The river itself, and all the smaller streams, had, in fact, 
ceased to be streams, and were no more than lines of detached pools, 
in the courses that had formerly been rivers. The Alentejo land, 
opposite Lisbon, is dry, superficially flat and sandy, and very un- 
healthy. So also is Salvatora, a large village about a mile inland. 
"The country around is perfectly open, though very low, and 
flooded with water during the whole of the rainy season ; but at 
the time of the periodical sickness, it is always most distressingly 
dry." " Cividad Eodrigo affords another illustration of the same. 
It is situated on a rocky bank of the Eiver Agueda, a remarkably 
clear stream ; but the approach to it, on the side of Portugal, is 



160 PNEUMONIA AND 

through, a bare, hollow country, that has been likened to the dried- 
up bed of an extensive lake ; and upon more than one occasion, 
when this low land, after having been flooded in the rainy season, 
has become as dry as a brick-ground, with the vegetation utterly 
burned up, there arose fevers to onr troops, which, for malignity of 
type, could only be matched by those before mentioned on the 
Guadiana." Corea, in Spanish Estremadura, on the banks of the 
Alagon, is highly unhealthy. Yet at the time the British troops 
suffered there, the shores of the river seemed perfectly dry, and 
there was not an aquatic weed, nor a speck, nor a line of marsh to 
be seen within miles of the town, nor anything but dry, bare, and 
clear savanna. From the foregoing facts, as Dr. Ferguson remarks, 
it will be seen that, in the most unhealthy parts of Spain, we may 
in vain, towards the close of the summer, look for lakes, marshes, 
ditches, or pools. Spain, generally speaking, is then, though as 
prolific of endemic fever as Walcheren, beyond all doubt, one of 
the driest countries in Europe, and it is not till it has again been 
made one of the wettest, by the periodical rains, that it can be called 
healthy or habitable with any degree of safety. 

Dr. Ferguson's observations in the West Indies led him to the 
same conclusions. " It might there be seen, that the same deep, 
marshy country which the rains made perfectly healthy, as if by 
deluging a dry well, was speedily converted, under the drying pro- 
cess of a vertical sun, into a hotbed of pestiferous miasmata. Thus, 
in the Island of St. Lucia, the most unwholesome town of Castries, 
at the bottom of the Carenage, which is altogether embosomed in 
a deep mangrove fern, became perfectly healthy under the periodic 
rains ; while the garrison, on the hill of Morne Fortune, imme- 
diately above it, within half cannon-shot, began to be affected with 
remittent fever. The two localities within this short distance 
evidently changed places in respect to health. The top and 
shoulders of the hill had been cleared of wood, and during a con- 
tinuance of dry weather, the garrison had no source of disease 
within itself; but this was amply, though but temporarily supplied, 
as soon as the rains had saturated the soil on which it stood. Thus, 
an uncommonly rainy season at Barbadoes seldom failed, in that 
perfectly dry and well-cleared country, to induce for a time general 
sickness ; while at Trinidad, which is almost all swampy, and the 
centre of the island may be called a sea of swamp, where it always 
rains at least nine months of the year — if it only rained eight, or 



AUTUMNAL FEVEES. 161 

if at any time there was a cessation of the preserving rains, the 
worst kind of remittent fevers were sure to make their appearance. 
General dryness of soil, however, is far from being the ordinarj^ 
characteristic of our West India colonies. The swamp is too often 
exposed to the continued operation of a tropical sun, and its ap- 
proach to dryness is the harbinger of disease and death to the 
inhabitants of its vicinity. On the whole, it may truly be said, 
that although excessive rains will evidently cause the acknowledged 
wholesome and unwholesome soils to change places for a time, in 
respect to health, a year of stunted vegetation, through dry seasons, 
and uncommon drought, is infallibly a year of pestilence to the 
greater part of the West India Colonies." 1 In all cases, however, 
previous saturation of the soil is necessary to insure the effect, and 
fever ceases when the exsiccation is thorough and complete. 

On all these points, other facts, numerous and authentic, may be 
found in other writers on the fevers of Europe, of the West Indies, 
of Mexico, South America, Africa, and this country. 2 Indeed, we can 
scarcely open a book, large or small, which treats of the subject in 
extenso or incidentally, without finding therein a repetition of the 
same story — absence of fever during excess of terrestrial humidity ; 

1 Marsh Poison ; see Notes and Recol. of a Professional Life, 186, 198. 

2 Baglivi, 157-9 ; Ramazzini, Opera Omnia, London, 1717 ; Rochoux, 11 ; Berthe, 
51, 156; Pariset, 177; Fellowes, 13, 32, 35; Boyle, Ed. J. viii. 178; Beam, Tr. of 
Med. Soc. Lond. v. 335; Report on Gibraltar Fever, 4; Caillot, 121; Furlong, Med.- 
Chir. Rev. xxv. 290 ; Valentin, 87, 89 ; Lempriere, i. 26, 31 ; ii. 47, 48, 49 ; Des- 
portes, i. 52, 80, 86, 87; Ferguson, Med.-Ch. Tr. viii. 130-1; H. M'Lean, 25, 72; 
Gillespie, 20, 137; Johnson, Trop. CI. 362; Dazille, Mai. des Negres, 10; Firmin, 
Mai. de Surinam, 3, 18; Bancroft, 200, 314; Edinb. J. lxiii. 448; Ibid., lxix. 132; 
Bally, 304, 363; Hillary, 146-7; Jackson, Outlines, 92; Tullock's Rep. 64; Gilbert, 
4, 50, 69; Rufz, 10, 29 ; Catel, 9 ; Beguerie, 10; J. Clark, 75 ; Towne, 8; Leblond, 229; 
Imray, Ed. J. liii. 93; lxiv. 331 ; Pinkard, ii. 486; Henderson, 8; Arnold, 31, 148, 
174; Chisholm, i. 145, 294; ii. 196; Humboldt, 765; Boussingault, An. de Chimie, 
lvii. 151 ; Boteler (Voy. of Disc, by Capt.), i. 137, 155, 156, 356; Pallas, 109; Prit- 
chett, 266; M'Williams, 176; Boyle, 6, 44, 123; Brit, and For. Med.-Chir. Rev. i. 
382; Jacquot, 14; Simon's Rept. to Bd. of H. of Charleston, 6, 10, 18; Watts, Med. 
Reg. of N. Y. 278; Barton, 13; Revue Med., 1840, 322; Merrill, Chapman J. ix. 
233, 240; Ibid. N. 0. J. viii. 7 ; Ibid. N. A. J. ii. 218 ; Rush, iv. 154; Chabert, 20; 
Lining, ii. 407; Townsend, 263; Barton's J. ii. 22; Drake, 717; Gros, 5; Johnson, 
Charleston J. iv. 155; Hulse, Maryland J., Jan. 1841, 392; Thomas, 18, 63, 213; 
Pendleton, Charleston J. vii. 449 ; Merrill, Address on Health and Mortality of Mem- 
phis, Recorder, i. 88; Bonnet, Tr. des Fievres Interna. 304; Craigie, Pract, of Med. 
i. 82; ii. 171; Villerme, An. d'Hyg. xi. 349, 350; Goupilleau, Bulletin de l'Acad. i. 
456 ; iii. 306 ; Sigand, Du Climat et des Mai. du Brezil, 70-2. 

11 



162 PNEUMONIA AND 

occurrence of the disease under the influence of the drying process ; 
again, absence of fever when the exsiccation of the soil is complete, 
and penetrates to a considerable depth, and every particle of moist- 
ure has been destroyed; and afterward reappearance of disease 
during the wetting period. 

It must be remarked besides, and more especially in reference to 
the facts adduced by Dr. Fordyce, in support of the power of 
moisture in producing fever, that most of the instances in which 
the disease is supposed to have arisen from that cause, occurred in 
situations more or less characterized by a marshy condition of the 
soil. Of all known localities, Batavia is the last that should have 
been selected as illustrative of the febrific agency of simple moisture. 
"It is impossible," says our countryman, Dr. Horsefield, who was 
well acquainted with the country, " for the imagination to conceive 
a situation more favourable to the production of marsh miasmata 
than that of Batavia." " If human industry and ingenuity should 
be exerted in planning and constructing a laboratorj^ for the pro- 
duction of pestilential vapours, a situation exactly resembling that 
of Batavia and its environs would be the result." 1 The same may 
be said of many other fever districts where moisture is sufficiently 
considerable to be made the subject of notice ; whenever the disease 
shows itself in localities which, though not containing marshes pro- 
perly speaking, are in that condition, we may be sure to find the 
soil presenting these peculiarities, which elsewhere are associated 
with the advent of fever, and act injuriously without the necessary 
coexistence of a notable amount of moisture. Here, consequently, 
the latter cannot be held up as the efficient morbific agent. It may 
be added that the instances mentioned by Dr. Fordyce, relating to a 
soil of pure sand, in which water was found in digging less than a 
foot deep, and occasioned a great moisture in the air, whence arose 
numbers of fevers ; in which the soil while giving passage to the 
excess of moisture adverted to remained perfectly dry, and in which 
there did not exist the least portion of organic matter susceptible 
of decomposition, may be regarded as of a very questionable cha- 
racter, none of them being mentioned on the authority of any re- 
sponsible writer, and some conflicting in the most positive manner 
with well-ascertained facts. 2 

1 American Med. Museum, i. 77. 

2 To Mr. Blodget, to whose Report on the Condition of the Summer of 1853, refer- 



AUTUMNAL FEVERS. 163 

A high dew-point not sufficient to account for the occurrence of fever. 
— For more reasons than one, objection may be made to much. 

ence has already been made, we are indebted for the following statements relative to 
the hygrometrical state of the atmosphere. 

The heats of June, in the summer of 1853, were remarkably dry. The fraction of 
saturation was at a mean of about 50 in the north-east, and but 40 to 45 in the inte- 
rior ; and in Texas, during the hot days, from the 14th to the 17th, though much higher 
at Pensacola and the extreme south, where the heat was not so great from the 20th 
to the 23d ; the rate was about the same in the districts of excessive heat. On the 
29th and 30th, the percentage was but 35 to 40 in the narrow district through Ten- 
nessee, Kentucky, and Virginia, which marked 100 as the maximum of temperature. 

The first two days of July were a continuation of the condition of the last of June. 
The remainder of the month was not unusual in its hygrometric character gene- 
rally, though at New Orleans the evidences of high saturation are given in the profuse 
and constant rains of the middle of the day, preceded by a hot and oppressive morn- 
ing. The great heat of August was most remarkable in its hygrometric condition, also, 
and universally attended with a high fraction of saturation ; at Washington, it was 50 
to 60 ; and at New York, where, whatever may have been the sickness and mortality, 
they did not arise from malarial fevers, and where no yellow fever occurred, the fraction 
of saturation was near 70 per cent, at 2 P. M., and almost at saturation morning and 
evening. 

Rains in August were excessive. 

The temperature of evaporation at New York in August was from 80 to 84, being 
higher than the maximum temperature of evaporation at New Orleans at any time in 
1852, by two degrees ; at the latter place, it reached 82 but once in that year ; with 
the exception of New Orleans and New York, at this limited period, the heats of the 
summer, though extreme, have been attended with a low humidity. 

In June, the amount of rain was much less than usual generally; in July, it was 
particularly large at Philadelphia, and southward to Florida, where it was 11°. 5 
inches. In Alabama, and at New Orleans, the amount was nearly as great, and in 
Iowa and Wisconsin, it was again large — from 6 to 8 inches. In some places, there 
were severe droughts, as in eastern Ohio, western Pennsylvania, and New York. In 
August, the rains were excessive from the lower part of New Hampshire to northern 
New Jersey ; at Bloomfield, New Jersey, and New York, the amount falling was 12 
inches. From Baltimore to Savannah, also, the amount was large, being from 5 to 
6.5 inches, and about 1J inches more than usual, the amount being about 3.5 inches. 
The last days of July, and the first days of August, gave an excessive precipitation 
in eastern Pennsylvania and New York, New Jersey, etc. These flooding rains, which 
gave in some instances 4 to 8 inches in depth of water in a single storm, of a few 
hours, attended very warm weather, and immediately preceded the heats of the 12th to 
the 14th of August. These were also followed by profuse rains, and the whole period 
from the 25th of July to the 15th of August seemed a substitution of a tropical 
climate for the usually elastic one, in the space of country referred to. — New York 
Journal of Medicine, November, 1853. 

Now it must be remarked that the hygrometrical conditions here referred to, ex- 
tended over a large surface of country, and that while some localities suffered severely 
from malarial fevers, of various grades and types, others similarly circumstanced in 
point of humidity, evaporation, and rain, escaped unscathed. To this agent, therefore, 
we cannot look for the efficient cause of the disease, even when it is combined with 
high atmospheric heat. 



164: PNEUMONIA AND 

of the theory set forth by our countryman, Dr. C. A. Lee, who, 
without discountenancing or disproving the existence of an aerial, 
intangible poison, looks for the main and most efficient cause of 
fever not, as some have done, in an excess of visible humidity alone, 
but principally in a high dew-point, however produced (60 degrees 
at least), which, as he thinks, acts injuriously in some measure, by 
checking the elimination of that poison from the system, and 
thereby giving it efficiency, but chiefly (and, as we may presume, 
exclusively in cases in which the poison does not exist, supposing 
the occurrence possible, which Dr. L. does not say), by interrupting, 
to a greater or less extent, the healthy function of the lungs and 
skin, preventing a perfect decarbonization of, and a sufficient supply 
of oxygen to, the blood — carrying off the vitreous electricity which 
acts as a vital stimulus, and, as a consequence, increasing the secre- 
tion of bile. 1 Still less disposed must we be to give our sanction 
to the views suggested, and so ingeniously supported by Mr. T. 
Hopkins, of Manchester, who seems to ignore malaria altogether, 
and attempts to identify it and a high dew-point, accounting for the 
production of fevers solely by the check thereby given to evapora- 
tion from the surface of the body. 2 

That a high dew-point has a tendency to produce injurious effects 
on the system ; that it is often found to exist in unhealthy localities, 
or during pestilential times ; and that it must assist somewhat in the 
development of autumnal and periodic fevers, are facts which no 
one will question. But that it plays the all-important part in the 
causation of those diseases attributed to it by Dr. Lee, and particu- 
larly by Mr. Hopkins, is far from being demonstrated. Were the be- 
lief correct, we should expect to find that a high dew-point — reach- 
ing to at least 60 degrees — is always attended with the occurrence of 
malarial fever in one or other of its various forms ; that countries 
or seasons in which the dew-point is high, are necessarily insalubri- 
ous; that this condition is proportioned to the elevation of the dew- 
point ; and that, on the contrary, localities in which the degree is low, 
are as necessarily healthy. Now let us inquire how far facts will 
bear us out on these points. We have seen that fevers, even of a 

1 Forry, Climate of the U. S. 112, 113. In a note, appended by Dr. Lee to the 
article Intermittent Fever, of Copland's Medical Dictionary, he is quite orthodox on 
the subject of Malaria, the existence and morbific agency of -which he fully admits. 
Not one word is there said about the dew-point. 

2 Lond. and Edinb. Phil. Mag. 3d S. No. 86, Feb. 1839; An. d'Hygicne, 25. 



AUTUMNAL FEVEKS. 165 

severe and malignant character, have not unfrequently broken out, 
and spread extensively, in places where but little visible humidity 
existed ; where the soil was arid, dry, and cracked, and everything 
upon it was parched in consequence of long-continued and severe 
drought ; where the absence of rain was not compensated by fogs 
and dews, and where, as a natural result, the dew-point was found, 
or might be inferred, not to have reached very high. We have 
seen, on the other hand, that the same or other places, have re- 
mained exempt from those diseases, under hygrometrical condi- 
tions of an opposite character, combined with a degree of heat well 
calculated to promote an excess of atmospheric moisture, visible 
and invisible ; and when, from these circumstances, the dew-point, 
if not positively ascertained to have been high, may, with perfect 
propriety be supposed, in the absence of direct observation, to have 
risen considerably. It may be remarked, also, that in places sub- 
ject to occasional visitations of autumnal fever of various grades of 
intensity, sickly seasons are not necessarily characterized by a higher 
dew-point than the corresponding periods of other years in which 
the disease does not make its appearance. 

In Demerara, the height of the dew-point in ordinal seasons diners 
but slightly from that to which it reached during the prevalence of 
the fever of 1837-1845. In 1843, the mean degree was 73.8, vary- 
ing from 72. (Feb.) to 74.9 (July, Aug., Nov.) In 1844, the average 
height was 75.1, with a variation of from 73.3 (Dec.) to 76.0 (May). 
In 1845, eight months give us a mean of 74.6 — from 73.0 (Jan.) to 
76.0 (April), while, in 1846, the year after the cessation of the dis- 
ease, the mean dew-point was 74.4, with a variation of from 70.8 
(Feb.) to 76.2 (May and June). 1 

The following table of the dew-points during the months of June, 
July, August, September, October, and November, from 1845 to 
1851, and July, August, and September, 1852 inclusive, at Charles- 
ton, S. C, will show to those who are aware that the yellow fever 
prevailed there during only two of those years (1849 and 1852), 
that the difference in regard to the saturation of the atmosphere 
during sickly and healthful seasons is but trifling, and cannot alone 
account for the production or absence of the disease ; and, indeed, 
that the results obtained are very different from those that might 
have been expected did a high dew-point and fever stand in the 
relation of cause and effect. 2 

1 Blair, op. cit. 120. 2 Hume, Charleston Journal, v. 10 ; viii. 67. 



166 PNEUMONIA AND 





June. 


July. 


Aug. 


Sept. 


Oct. 


Nov. 


1845 


69.46 


72.77 


71.96 


66.00 


54.61 


41.00 


1846 


70.83 


72.82 


75.64 


70.66 


59.22 


50.46 


1847 


71.74 


73.39 


74.23 


68.20 


58.67 


53.53 


1848 


70.26 


73.00 


72.09 


66.26 


58.74 


44.80 


1849 


73.46 


70.77 


72.71 


66.00 


60.93 


53.13 


1850 


67.86 


75.03 


74.93 


69.70 


55.00 


50.86 


1851 


70.73 


74.38 


74.67 


65.13 


57.41 


48.23 


1852 




73.20 


68.77 


68. 







Tims the average dew-point in June and October of the sickly 
year of 1849, was higher than in the corresponding months of any 
year of the series ; but when we examine the results obtained in 
the other months, matters are found to take a different turn. For 
while in July, 1849, the average was 70.77, and in 1852, 73.20, we 
have a higher point than in the former in each of the other years 
of the series, and a higher one than in 1852, in the same month of 
1847, 1850, and 1851. The average in August, 1846, 1847, 1850, 
and 1851, was higher than in 1849, and higher than in 1852 in 
every year of the series. September in 1846, 1847, 1848, and 1850, 
gave a higher point than in 1849, while the amount in 1852 was 
exceeded by that in 1846, 1847, and 1850. 

In New Orleans, where the average annual dew-point, calculated 
on a basis of eight years, was found to be 63.56 (observed at 12 
o'clock), June being 73.95; July, 75.42; August, 75.59; September, 
73.63 ; October, 62.73 ; November, 54.27 ; the year 1849, during 
which both the yellow fever and cholera prevailed extensively, 
presents an average for the twelve months of 63.71 : June, 74.43 ; 
July, 75.53; August, 76.75; September, 73.78; October, 61.16; 
November, 57.71. l Indeed, the physicians of Louisiana have had 
frequent opportunities to observe the dew-point for months together 
only a few degrees below the atmospheric temperature, without, 
however, suffering from any extraordinary prevalence of intermit- 
tents. 2 

The above statements show, that the mean dew-point of the 
summer in Charleston and New Orleans, is several degrees above 
that of the autumnal season, when fevers are more apt to be pre- 
valent. In the latter city, the excess amounted to near nine 
degrees. In Charleston, the difference between the mean dew-point 

1 Southern Med. Repts. i. 100 ; ii. 148. 2 Carpenter, N. 0. J. iii. 428. 



AUTUMNAL FEVERS. 167 

of the three summer months of the seven years specified, and that 
of the three following months, reached above fourteen degrees. 
Dr. Gardner, in his essay on the dew-point, states the excess, in the 
United States generally, to be upwards of fifteen degrees. It is 
evident, also, from facts mentioned already, and from many others 
that might, if necessary, be added, that in all parts of this and other 
countries — in localities frequently or occasionally visited by yellow 
or other forms of malarial, fever — a dew-point of sixty or more 
degrees is often experienced months together without ill health, 
although the temperature be such as to promote the production of 
disease. On the other hand, as Dr. Gardner properly remarks, trie 
fens of Lincolnshire, Walcheren, the marshes of Holland, are pesti- 
ferous with a dew-point of less than fifty degrees. 1 

From these circumstances, viewed in connection with the fact so 
often referred to, that fevers occur in ships and circumscribed 
localities, while other ships and localities in the immediate vicinity, 
and placed under like meteorological influences, remain exempt; 
that the alleged effects are not found to be produced by a saturated 
atmosphere in the higher latitudes ; that seamen at sea are exposed 
with perfect impunity to an atmosphere saturated with moisture, and 
are attacked only when they land, indicate plainly the impropriety 
of attaching too much weight to the hypothesis in question, and 
must debar us from the possibility of connecting, as efficient cause 
and effect, a high dew-point and malarial fevers of various grades. 
The impropriety of the belief is farther proved by circumstances 
which Dr. Gardner appears to have established, i. e. that the de- 
tention of the insensible vapour from the lungs or the skin, by a 
high point, is much less considerable than it is represented by those 
who have urged the theory; that the dew-point in insalubrious 
places is often much lower than is thought, and that a high point 
does not arrest the separation of carbonic acid and the other con- 
stituents of sweat. Let us examine the effects produced as we may, 
and concede to a high dew-point what extent of agency soever we 
may think to be warranted by the nature of the facts observed, as 
well as by the well-known influence of atmospheric moisture, we 
arrive always at the conclusion that something more is necessary 
to enable us to account for the development of fever; that, by itself, 
a high dew-point will not occasion the disease ; that, therefore, its 

^ l American Journal, ii. N. S. 107. 



168 PNEUMONIA AND 

agency is of a secondary character, and consists, perhaps, as Dr. Lee 
supposes, in checking the elimination of the febrific poison, but more 
surely in predisposing the system to the action of the true efficient 
cause, by hindering a natural escape from the blood of those materials 
which constitute the liability to the disease, or maintaining them in 
a condition favourable to the morbid change ; as, also, like visible 
humidity, in promoting, when aided by other influences, those re- 
actions, between the remains of organic and inorganic matters on 
which the evolution of the morbific agent depends. 

Heat and humidity combined not the efficient cause of fever. — From 
the foregoing facts and considerations, we may conclude that neither 
heat nor moisture, when acting separately, can be productive of 
autumnal and kindred fevers. Equally objectionable is the be- 
lief that such diseases arise from the combined influence of those 
two agencies. In most of the instances mentioned, humidity, when it 
existed, was associated with atmospheric heat, and yet the combina- 
tion failed to prove injurious. Dr. Drake remarks, in corroboration, 
that autumnal fever seldom appears on board of vessels which 
cruise in the Gulf of Mexico, although the air, at the temperature 
of 80°, is nearly saturated with vapour ; that the inhabitants of Key 
West, who breathe a similar atmosphere, are much less afflicted 
with the fever than those on the Peninsula of Florida, several 
degrees farther north ; that the pine woods around the Gulf of 
Mexico, at the distance of only two or three miles from the estua- 
ries of the rivers, are places of retreat from fever, although there 
is a sea and land breeze which tends to equalize the humid atmo- 
sphere ; that the inhabitants of the Balize suffer less from the fever 
than those along the rivers of the interior of Louisiana, two or three 
degrees farther north, notwithstanding they are immersed in an 
atmosphere of great heat and vapour; that, at our different salt 
works, the operatives spend their lives in a hot atmosphere, satu- 
rated with vapour, and yet, on the whole, are more exempt from 
fever than the surrounding population ; and, lastly, that in some of 
our manufacturing establishments, the in-door artisans and opera- 
tives labour in a heated atmosphere supersaturated with vapour, 
but remain free from autumnal fever. To this it may be added, 
that in the plains of Meta, situate on the east side of the Cordilleras, 
fever does not prevail extensively, while in the valley of the Mag- 
nalena, on the west of those mountains, it is of almost constant 



AUTUMNAL FEVERS. 169 

occurrence ; yet the state of the barometer, as well as the hygro- 
metrical variations, are the same in both places. 1 

These various facts, showing the innocuousness of the combination 
in question, lead to the inference that, when the prevalence of fever 
happens to be associated with the existence of heat and moisture 
combined, the cause of the disease is not to be sought in the latter, 
inasmuch, particularly, as we find that febrile complaints occur 
often, and spread widely and fatally, without any such combination. 
Humidity, therefore, if instrumental in producing fever — and no 
one will deny the fact — must, as already stated, act in a secondary 
capacity ; and, instead of being regarded as the efficient cause when 
alone or combined with heat, must be viewed as merely aiding in 
the elimination of the latter, and predisposing the system to its 
morbid effects. 

Vicissitudes of temperature will not account for the occurrence of periodic 
fever. — Neither can we admit the propriety of referring the efficient 
cause of autumnal and kindred fevers to the difference of tempera- 
ture between day and night, or to mere atmospheric vicissitudes — 
the succession of cool or cold nights to hot days ; nor the sudden 
exposure of the body, at any period of the twenty -four hours, to a 
low degree of temperature after it has been placed for a greater or 
less extent of time under the influence of a high degree. The 
agency of such vicissitudes were noticed as early as the days of 
Hippocrates. Hoffman sets them down as the general remote cause 
of epidemic fevers, and after him, several writers, among whom 
Broussais 2 and Dr. Dundas 3 figure conspicuously, have laid much 
stress on their efficiency, and displayed considerable ingenuity, in 
endeavouring to explain the manner in which the morbid effects 
are brought about. But " after carefully examining what the advo- 
cates of the opinion have adduced in its support, it appears to me 
that were atmospheric vicissitudes the efficient agent in the pro- 
duction of periodic and other forms of malarial fever, we might 
expect to find these diseases prevailing principally in seasons in 
which the number of dew or cold nights following on hot days is 
greatest. We should be justified also in expecting malarial fevers 

1 Boussingault, An. de Chimie, lvii. 153-4. 

2 Commentaires des Propositions, No. 227, pp. 672-3. 

3 Sketches of Brazil ; including New Views on Tropical and European Fevers. 
London, 1852, 205. 



170 PNEUMONIA AND 

to occur not once or occasionally, but frequently, if not univers- 
ally, whenever the supposed cause manifests itself; or, rather, it 
ought to be found that every time such fevers prevail — sporadic- 
ally or epidemically — the difference of temperature between day 
and night is greater than in healthy seasons. We should besides 
expect to find them appearing, not sporadically only, but in an epi- 
demic form, as well in clean, well-paved, and well-aired cities, where 
atmospherical vicissitudes are as apt to be felt as elsewhere, as on 
the borders of creeks, rivers, and lakes, and in meadow lands, in 
level plains or marshy localities ; and whenever a man whose body 
has been overheated is suddenly exposed to a cold atmosphere, or 
plunged into a cold bath, he ought to be regarded as no less liable 
to suffer from an intermittent, a remittent, or a yellow fever, of the 
most legitimate kind, than from a pleurisy, a catarrh, or any other 
kindred disease. But so far from this being the case, experience 
shows that fevers occur and prevail extensively in situations where, 
and at periods when, such vicissitudes are not felt at all, or are so 
to too inconsiderable an extent to be productive of the baneful 
effects ascribed to them ; and, on the other hand, that those diseases 
are either seldom felt or completely unknown in localities where 
or seasons when, sudden changes of temperature, or the contrast 
between night and day, are as common and noted as, if not more 
so than, in places, and at times remarkable for insalubrity. 
Surely a morbid agent which, if it really exercises any influence in 
the production of autumnal fevers, does so only in localities of a 
special kind, where, let it be remembered, those fevers often appear 
and even abound without its aid ; an agent which habitually fails 
to produce those same fevers in localities of a different kind ; which 
produces the effect ascribed to it only in a certain season of the 
year, however manifestly it may show itself at other periods, and 
whose known ordinary products everywhere and at all times, are 
diseases very different in every respect from those in question ; 
such an agent, I say, cannot lay a just claim to be held in the light 
of the efficient or necessary cause of the latter. 

The climate of Newfoundland is marked by sudden and fre- 
quent vicissitudes of atmosphere ; notwithstanding which, however, 
fevers are scarcely known there, even among those most exposed. 1 
The whole coast of this continent, from one extremity to the 

1 Tullock, Sickness, &c. of British Army in British America, 35. 



AUTUMNAL FEVEES. 171 

other, is proverbial for the frequency, suddenness, and extent of 
such changes ; and yet, while some localities are annually the seat 
of the pyrexia! complaints under consideration, others, equally sub- 
ject to the former, remain untouched by the disease. Nay, vicissi- 
tudes, if really the efficient cause of malarial fevers, appear to be 
whimsical in their operations. See, for example, how they com- 
port themselves in Charleston. The autumnal seasons of 1849 and 
1852 were decidedly malarial. During the months of July, August, 
and September of the first, the number of nights of dew, with high 
temperature during the day, amounted to 51, and far exceeded that 
of 1845-8 and 1851, and by 8 that of 1850, in neither of which 
years did the yellow fever prevail. So far, therefore, there seems 
to be some connection as cause and effect between cold nights with 
hot days and fever. But when we come to inquire into the results 
obtained in 1852 — which was a decidedly malarial year, as evi- 
denced by the occurrence of both the yellow fever and dengue, we 
find that the number of dew-nights amounted only to 39, or 4 less 
than in 1850, when there was no malarial developments, and the 
range of the temperature was greater. For this fact, we are in- 
debted to Dr. Hume, 1 already referred to. The range in 1849, dur- 
ing July, August, and September, amounted to 1,524 degrees (the 
minimum or night temperature being 63.92, and the maximum or 
dry temperature being 79.16), and exceeded by far that of 1845- 
6-7-8-50-51. But the range in 1852 was only 1,284 (minimum 
66.25, maximum 78.91), being only 26 degrees higher than the 
range of 1851, and less by .82 than that of 1850, when the mini- 
mum was 68.00, and the maximum 81.58. In a word, the resem- 
blance of 1850 and 1851 with 1852, is too striking in this and 
other respects, to make us attach much importance to this point. 2 

It may not be improp'er to remark, 1st, that persons who take 
the fever are seldom sensible of having felt the effects of atmo- 
spheric vicissitudes, and often have been placed, purposely or acci- 
dentally, beyond the possibility of experiencing these — supposing 
them to occur. 2d. That the cold, incident to such vicissitudes, acts 
on organs different from those concerned in the development of pe- 
riodic or malarial fevers. Producing its first impress on the skin, 
it affects most frequently those parts which act as supplements to 
that eliminating tissue — the lungs, and the urinary passages. Other 

1 Charleston Journal, viii. 67. 2 Hume, op. cit. 58. 



172 PNEUMONIA AND 

parts, of course — even the abdominal viscera — are sometimes impli- 
cated, but the symptoms which then occur bear no resemblance to 
those of autumnal fevars, unless other causes have co-operated. 
That the cold felt under the circumstances is instrumental in ex- 
citing or multiplying attacks of malarial fevers, is no doubt true ; 
but it does in regard to these diseases what it effects in regard to 
many other complaints; and it would be wrong, from its agency in 
those cases, to argue that it is the efficient cause of the disease ; for, 
alone, it cannot give rise to anything of the kind. More rational is 
it to view it as having simply aroused from its slumbers a morbific 
influence floating in and impressing the system in a slow and invisi- 
ble manner, and requiring, for its outward manifestation, the dis- 
turbing influence of some other agency. The same result attends 
the action of atmospheric vicissitudes an regard to diseases of a 
specific nature, and which no one would have the hardihood to 
ascribe solely to such a cause. What the latter does as respects 
malarial fevers, it does, for example, in regard to mercurial ptya- 
lism in persons whose systems have been impregnated with mer- 
cury; but in whom the affection of the mouth has not yet been 
developed. In such instances, exposure to atmospheric vicissi- 
tudes — to cold, however applied, especially when the system has 
been previously heated — will hasten and increase the elimination 
of the poison, and salivation will be established. The same remarks 
apply equally well to hydrophobia, which has not unfrequently 
been developed through the agency of the cause in question. 
Nothing is more dangerous than the action of atmospheric vicissi- 
tudes, or cold, on individuals bitten by the lanceolated trigono- 
cephalus of the Antilles. The same injurious effect is said to be 
experienced by individuals who have been exposed to the action 
of the mancinella and the Rhus toxicodendron. 1 

In all these instances of change from heat to cold, the latter has 
acted simply as an exciting cause, and must be ranked with, for it 
acts much in the same way as, several other agencies — intemperance 
in eating or drinking, venereal excesses, exciting and depressing 
passions of the mind, &c. — which no one in his senses can feel dis- 
posed to regard as capable of producing periodic or malarial fevers, 
any more than of producing ptyalism or hydrophobia. 

1 Boudin, G£og. M6d. 67. 



AUTUMNAL FEVERS. 173 

The attach is sometimes too sudden, and follows on too transient an ex- 
posure to infected regions, without appreciable atmospheric vicissitudes, 
to he the effect of these or any other kindred cause. — It is not less 
true that the attack comes on often too suddenly, is too palpably- 
connected with a transient exposure to an unhealthy spot; and 
appears under circumstances which too evidently shut out the idea 
that atmospheric vicissitudes have had an agency in its production, 
to justify us in viewing these in the light of the efficient cause of 
the disease. Who has not seen or read of persons being seized 
with intermittent, remittent, or yellow fever, after a single and mo- 
mentary exposure, not at night only, but sometimes during the day, 
to the atmosphere of infected localities, who, before such exposure, 
had borne, with perfect impunity, as thousands of other indivi- 
duals were continuing to do, the thermometrical vicissitudes of 
neighbouring localities. The facts on the subject mentioned by 
Humboldt, respecting persons taking the yellow fever in conse- 
quence of passing through Vera Cruz in a litter, with a view to 
embark, are familiar to most readers, 1 and others of similar im- 
port may be easily gathered from the annals of periodic fevers. 
I could, if necessary, relate several instances of individuals who 
have been seized -with yellow fever after remaining but an hour or 
two in the city of Havana. The history of all our epidemics fur- 
nish us with examples of the sort. In 1798, Dr. Cooper, who was 
residing at Bush Hill, imprudently visited the infected district, and 
was a short time after attacked. During the fever of 1820, in this 
city, a young man, residing in a healthy district, jumped over the bar- 
ricades, walked through the deserted streets for a few moments, and 
paid the penalty of his imprudence. " If my own frequent observa- 
tions," says Macculloch, " show that fever may be induced within 
half an hour after exposure to malaria, and that a single inspira- 
tion, in the space of a very few seconds, is amply sufficient for the 
purpose, this is also an opinion most decidedly stated by many 
French and Italian physicians, whose experience and acuteness will 
not be questioned. It is equally the opinion of others elsewhere, 
not physicians, and therefore without the bias which might be 
suspected in such cases; of military, and chiefly of naval men, 
whose observations have been founded on the momentary and 
transitory effects of a breeze of wind, and especially of a land-wind 

1 Nouvelle Espagne, 4to. ed. 773-4. 



174 PNEUMONIA AND 

blowing off to sea. In France and Italy, to confirm this, instances 
are known and recorded, of labourers dying instantaneously from 
merely sitting or lying down on the ground, and of others who, 
from looking into a ditch or drain, have been struck dead by that 
poison, which, of course in a minor degree, has merely produced a 
fever." 1 But as these statements may be objected to on the score of 
the tendency to exaggeration with which Macculloch has, perhaps 
not unjustly, so often been charged, it may not be improper to re- 
mark that the fact of infection after transient exposure, derives 
ample support from the asseverations of other writers whose testi- 
mony cannot be impugned. Lancisi relates that of a party of 
thirty gentlemen and ladies of rank in Eome, who made an excur- 
sion towards the mouth of the Tiber, the wind suddenly shifted, 
and blew from the south over the marshes, when twenty-nine were 
soon seized with a tertian fever. 2 " The marines," says Lind, " who 
were three times a week exercised early in the morning on South 
Sea Beach (in 1765), from the effect of the stagnant water of an 
adjoining morass, suffered much. Half a dozen of them at a time 
were frequently taken ill in their ranks, when under arms; some 
were seized with such a giddiness in the head that they could 
scarcely stand; others fell down speechless, and, 'upon recovering 
their senses, complained of a violent headache. When such pa- 
tients were received into the hospital, some few had a regular ague, 
but far the greater number laboured under a remitting fever, in 
which sometimes, indeed, there was no perceptible remission for 
several days." 3 Ferguson says, of Monk's Hill: "It was the 
duty of the white troops, in both these forts, to take the guard and 
duties of the dock-yard amongst the marshes below, and so pestife- 
rous was their atmosphere that it often occurred to a well-seasoned 
soldier, mounting the night-guard in perfect health, to be seized 
with furious delirium while standing sentry, and, when carried back 
to his barracks on Monk Hill, to expire in all the horrors of the 
black vomit, within less than thirty hours of the first attack." 4 
The same writer states that, during the advance of the British army 
from Oporto in 1809, the troops took up their bivouac in the dried- 

1 Essay on Remittent Fever, &c. i. 16. 

2 De Nox. Palud. Effl. lib. ii. cap. 3. 

3 Dis. of Hot. Clim. 24, 5. See, also, 32, 89; 159-160; 240-242. lb. on Sea- 
men, 81. 

4 Marsh Poison, in vol. of Recollections, 194-5. 



AUTmiXAL FEVEKS. 175 

up beds of the mountain streams. These localities proved highly 
unhealthy, and several of the men were seized with violent remittent 
fever before they could move from the bivouac the following morn- 
ing. 1 Dr. Celle, in his Hygibie des Pays Chauds (79), relates the fol- 
lowing instance of the sudden influence of miasma : "In 1844, eight 
soldiers, an officer, and a custom-house agent, were sent from San 
Bias to the environs to surprise a convoy of silver which had been 
reported as about being embarked by contraband. They con- 
cealed themselves in a thicket, close to a marsh. An hour after, 
they were all seized with vertigo, nausea, vomiting, and an exces- 
sively violent chill ; in such a way, indeed, that the convoy passed 
without one of the men being able to rise from the ground to seize 
it." The same writer states that similar occurrences are noticed 
among the soldiers and custom-house officers stationed at the en- 
trance of the port of Mazatlan. The station is situate between the 
sea and a marsh. The men are on duty during twenty -four hours 
only, yet, at the end of this short time, it generally happens in the 
rainy season that they all return with fever or dysentery (80). " It 
is a curious thing," says an official document, " to see six men sent 
ashore in perfect health, return on board ten minutes after, all six 
labouring under fever." 2 ISTepple relates the history of eight men 
who, during the hot weather of August, 1825, were employed in 
thrashing in a barn situate in the immediate vicinity of a source of 
infection near the town of Montluel. They were all seized the same 
day with intermittent fever of greater or less violence. 3 

Before the English raised the blockade (of Batavia) parties of 
men and officers were sent on shore at Edam, to blow up and de- 
stroy the works and buildings on the island, which operations de- 
tained them about half the night there. Most of them were shortly 
afterwards attacked with the fever. 4 Mr. Lander, surgeon to Lord 
Kothe's regiment of horse, communicated the following informa- 
tion to Sir John Pringle : Most of the men were first taken ill 
upon their return from forage ; for, the regiment being cantoned 
upon the right and left of St. Michael's Gestel (their principal 
quarters), close upon the inundations, and many of the quarters 
being above two leagues from Bois-le-duc, where the magazines 

1 Ibid. 2 Admiralty Reports. 

3 Fievres Intermittentes, 142. See. for other cases of similar kind, Second Rep. of 
Lond. Commiss. for 1848, 96: Bryson, 205: Johnson on Trop. Climates, 127. 

4 Johnson on Tropical Climates, 134. 



176 PNEUMONIA AND 

were kept, the men were obliged to set out about four in the 
morning, in order to get back before the greatest heat of the day. 
At this early hour, the meadows and marshes on each side of the 
road were covered with a thick fog of an offensive smell, which 
Mr. L. considered as the chief cause of the sickness. For, although 
the party generally returned before noon, several among them were 
already in a fever, and some actually delirious ; nay, a few on their 
way home were so suddenly taken with a frenzy, as to throw 
themselves from their trusses into the water, imagining that they 
were to swim to their quarters. 1 

Mr. Grainger, in his testimony before "the London Commis- 
sioners," quotes a letter from a medical practitioner : " I was passing 
the drain-grating at the corDer of Union and Bond Street, when I 
perceived a most faint and disagreeable smell arising from it. Being 
immediately attacked with nausea and an indescribable sensation of 
illness, I at once returned home, and drank half a wineglassful of 
brandy. After a short time the indisposition appeared to pass away, 
but the peculiar smell of the drain still remained in my nostrils. I 
had to visit a patient near Manchester Square, that evening, and 
whilst in the house, I felt so ill that I immediately returned home 
and went to bed. At that time my head ached violently. I had 
nausea, pain in my back, and an unpleasant taste in my mouth. 2 " 

All these cases, and others equally striking, which it would be 
easy to adduce, show, beyond the possibility of denial, that periodic 
or autumnal fevers, of all grades and forms — from the most trifling 
to the most malignant — are often produced almost suddenly by the 
shortest possible exposure to sickly localities ; and it is certainly 
difficult to understand how atmospheric vicissitudes can alone be 
looked upon as the chief agent in the production of such diversified 
effects ; seeing especially that the morbid changes to which they 
usually give rise differ materially from those under present con- 
sideration. Add to this, that atmospheric vicissitudes are not 
greater, and cannot be more deleterious near to, or to the wind- 
ward of a morass, than at a short distance from, or to the leeward 
of it ; along the margin of a lake or river, than on its surface a few 
hundred rods off; in a sickly port than at a short distance outside ; 
and that, if they produce the fever in the former, there is no reason 
why they should not do so equally well in the latter. 

1 Pringle, 177-8. 2 Kept. 1848, 96. 



AUTUMNAL FEVERS. 177 

Fever not the effect of a particular electrical state of atmosphere. — 
Not more satisfactory is the hypothesis that the efficient and neces- 
sary cause of autumnal fever must be sought in some particular elec- 
trical or magnetic state of the atmosphere. On this subject we 
know too little to form even a plausible conjecture ; and I hazard 
nothing in affirming that the various theories of Giannini, Mur- 
ray, Craig, Shecut, Eumph, Pallas, and others, have failed to 
satisfy medical inquirers of sound judgment. The sphere of pre- 
valence of the disease is often circumscribed within such narrow 
and well-defined boundaries, that it is difficult to perceive the pro- 
priety of regarding it as due to any modification in an agent of the 
general and wide-spread character, necessarily possessed by the 
one under consideration. This modification, whatever it may be, 
whether it consist in an excess or deficiency of the fluid, extends 
far and wide, and cannot fail to exercise its influence, as well at a 
distance from, as within the precincts of, the sickly district; and 
were the theory correct, we should not hear of, and every day see, 
instances of fever being arrested by a street, a wall, or the like ; or 
extending its ravages over a very limited surface of ground, in a 
single ship, or side of a ship, on one side of a street, &c. The same 
modification in the electricity of the atmosphere must have existed 
beyond those narrow limits ; and if it were the sole cause of the fever 
on one side of the barrier, it would in all probability have produced 
a similar effect on the other. Some other agent, then, must have 
been at work in the former, which did not exist in the latter. It 
matters not whether the sickly locality covers a small area of 
ground, or extends over a wide surface, the necessity of that pecu- 
liar agent must be admitted ; and while it would be improper to 
deny that a modified state of atmospheric or terrestrial electricity 
exercises an influence in the formation of the supposed agent, and, 
in addition, predisposes the system to be morbidly affected by it, 
we must necessarily absolve it from the charge of acting as the sole 
efficient cause of the disease. 

The preceding facts lead to the belief in a poisonous agent floating 
in the atmosphere. — All the above hypotheses failing to account for 
the effects in question, we are naturally led to the admission that they 
are produced by the morbific influence of some special agent ; and 
when we take into consideration all the circumstances attending the 
appearance of febrile diseases, the circumscribed sphere of their 
12 



178 PNEUMONIA AND 

prevalence, the suddenness of their attack, the character of their 
phenomena, &c, we may safely say that there is nothing left but to 
attribute them to the action of some poison dissolved or suspended 
in, and contaminating the air of the infected locality ; which poison, 
while doubtless requiring for its development and dissemination a 
certain degree of heat and terrestrial and atmospheric moisture, a 
certain amount of nightly condensation after evaporation, and the 
presence of fermenting or decomposing materials, cannot be pro- 
duced by either of these agencies alone ; and, though undetected by 
the chemist, betrays its presence by producing on those exposed to 
its influence the peculiar morbid changes characterizing fever. 

The innocuousness of some marshes, and of localities similar to those 
that are sickly, no proof of the non-existence or non-agency of malaria. — 
That marshes and swampy surfaces — using these terms in their more 
enlarged sense — collections of organic substances in a state of de- 
composition, &c, do not occasion the effect in Question always and 
everywhere; that ships at sea and in port, though often superabund- 
antly filled with such materials of decomposition, are not invariably 
the seat of febrile developments in a sporadic, and especially in an 
epidemic form, all must know who have paid attention to the sub- 
ject. During particular seasons, in places presenting some of the 
peculiar characteristics specified, cases of fever abound. During 
others, and sometimes during a succession of seasons, the disease 
is scarcely, if at all seen. In the quebradas of Peru, fevers are 
often general, and assume the garb of wide-spreading and malignant 
epidemics. This continues a year or two, during which the mortal- 
ity becomes very considerable. At the end of that time a favoura- 
ble change takes place, and the country once more becomes healthy. 1 

In a medical report of the House of Eecovery of Dublin for 
1829, Dr. O'Brien says : "Intermittent fever has been a rare disease 
in Dublin, and, we may add, in Ireland. During a period of twenty 
years, through which the author's experience extends, a few inci- 
dental cases only of the disease occurred, from time to time, in his 
hospital and dispensary practice, and those few were persons who 
brought the disease from England. A singular revolution has 
taken place in Dublin for the last two years with respect to inter- 
mittent and continued fevers ; the latter disease, which, for a cen- 

1 Ulloa, Mem. Philos. i. 245. 



AUTUMNAL FEVERS. 179 

tury, had been the constant scourge of this city, has considerably 
declined, and intermittent fever has sprung up, and occupied its 
place. For the last four months, however, up to February, 1830, 
intermittent fever has again disappeared, and I am happy to say, 
without a corresponding increase of continued fever." 1 

I shall not stop to show that the same alternation of healthy and 
sickly periods in localities where, from the nature of the soil, and 
some of their external conditions, fever might at first sight be ex- 
pected to arise annually, has been noticed in this country and else- 
where. The task would offer no difficulty, for facts to the point 
could be abundantly supplied by the Transactions of our State 
Medical Society, 2 and a variety of works of easy access. But the 
subject has already been alluded to, and may be reverted to again 
under a different head, and must, besides, be familiar to all well- 
informed and observant physicians. 

It not unfrequently happens that in localities where, from the 
character of the soil, or the nature and condition of the substance 
by which the surface is covered, as well as from the heat and moist- 
ure of the climate, febrile complaints might be expected to occur, 
they are, nevertheless, seldom or never encountered. We have 
already seen that many parts of Scotland and Ireland that are 
occupied by large tracts of peat moss are completely free from 
these fevers, and that the disease is never seen among the inhabi- 
tants of the country bordering on the Dismal Swamp between Vir- 
ginia and North Carolina. The numerous and extensive marshes 
of Sweden, somewhat beyond the sixtieth degree of latitude, of 
Norway, of Eussia — near St. Petersburg, for example — of Laponia, 
&c, have, it is said, little influence on the mortality or salubrity of 
those regions ; intermittents and remittents not being endemic there ; 3 
and every one knows that, whatever be the condition of the towns 
and cities of these regions, or of Northern Europe generally, yellow 
fever, properly so called, has never, except perhaps at Copenhagen 
— and even this is open to doubt — made its appearance there. 

Intermittents are almost unknown on the banks of the Ehine from 
its source to Chur. Making their appearance near this place, they 

1 Dublin Med. Trans. N. S. i. 330-1. 

2 See Trans, of Med. Soc. of the State of Pennsylvania, ii. 51, 93. 

3 Monfalcon, 26 ; Acerbi Viaggio al Capo Norte ; Brocchi, op. cit. 277 ; Brit, and 
For. Med.-Chir. Rev. x. 367; Boudin, An. d'Hygiene, xxxiii. 116; Bang. Prax. 
Med. 36. 



180 PNEUMONIA AND 

continue to show themselves as far as Maienfeld, where they again 
disappear, to break out anew, and prevail from Strasburg to Bingen. 
At this spot they once more are lost sight of, and are not seen 
before reaching Cologne, and especially the delta of the above-men- 
tioned river. 1 

On the summit of the group of Calabrian mountains, denominated 
La Sila, the larger portion of which, formerly covered with forests, 
is at present under culture, are to be found extensive marshy 
localities. One of these, situate in the valley of the Crocifisso, 
between Cecio and Camiliati, is very large. From these marshes 
arise thick fogs, which float on the surface to the height of many 
feet, and continue to do so till dissipated by the action of the sun ; 
yet the peasants sleep with perfect impunity along the margin of 
these marshes during summer and autumn, and the proprietors re- 
side there the whole of that time in the Hotel or Casino of Cecio. 2 

It will be found that, in cold climates, periodic or malarial fevers, 
generally considered, diminish in frequency in proportion to the 
elevation of the latitude, but that in so doing they conform less to 
the direction of the parallels than to that of the isothermal lines. M. 
Boudin, 3 who has called attention particularly to this circumstance, 
remarks that, though but little prevalent at St. Petersburg, which, 
nevertheless, is surrounded with marshes and situate under the 
59° of north latitude, they cease to exist in Asia towards the 57°, 
whilst in Sweden, they show themselves as far as the 63° of the 
same latitude, and even reach, somewhat farther in a westerly 
direction, the Shetland Islands, and even Iceland. From this, it 
results that the northern limit of intermittent fever is in some 
measure represented by the isothermal line determined by an 
annual temperature of 5° centigrade, with a mean of in winter, 
and 10° in summer ; and that this line lowers in Central Asia and 
in North America below the 50° of north latitude ; whilst between 
those two continents and on the Atlantic Ocean it rises as high 
as the 67° of the same latitude. 

The marshy grounds on the south-west coast of Ceylon, between 
Negombo and Galle, do not seem to exercise much influence in the 
production of fever. Again, the island of Mauritius, in the Eastern 
hemisphere, resembles Jamaica in its physical characters. The 

1 Boudin, Fievres Intermittentes, 58. 

2 Brocchi Stratto Fiscio del Suollo di Rorna, &c. 278. 

3 Geographie M6dicale, 1G. 



AUTUMNAL FEVEES. 181 

temperature is the same ; it lies nearly in the same latitude, but to 
the south of the line ; morasses and marshy land occur as frequently 
in the one as in the other, and yet periodic fevers are rare in the 
Mauritius, and the mortality small from this cause; while, in 
Jamaica, the reverse is the case, remittent fever being a common 
and fatal disease. 1 

In many parts of New England, as far as the St. Lawrence, New 
Brunswick, Nova Scotia, and Lower Canada, Forts Moultrie, and 
Munroe, Hancock Barracks, West Point, etc., fever is seldom, if 
ever noticed, though, judging from the external appearances and 
position of those localities, some of which are at the outlet of rivers, 
and exposed to that combination of mud and marsh, regarded as 
its prolific source in other parts, there is nothing by which we can 
account for the exemption. 2 Dr. Drake, who has paid considerable 
attention to this subject, remarks that the geographical limits of 
fevers in this country are east of the Appalachian Mountains below 
the 33° of latitude, beyond which those mountains do not extend. 
Below that parallel, it has no eastern limit but the Atlantic Ocean. 
South-west, the Cordilleras of Mexico and the Southern Eocky 
Mountains, constitute its boundaries. In higher latitudes, it ceases 
in the great plains of our western desert, long before we reach 
those mountains. It is almost unknown at the distance of three 
hundred miles from the western boundary of the States of Missouri 
and Iowa, above the latitude of 37° N. To the north, it does not 
prevail as an epidemic beyond the 44° parallel, and ceases to occur 
even sporadically about the 47°. 3 

Dr. Carpenter states that on the bayous of the Louisiana delta, 
Lafourche and Terrebonne, for example, the habitable land is limited 
to narrow strips, of from a few hundred feet to a mile in width, 
which form the banks of the streams, and follow their windings, 
and which are surrounded on all sides by swamps and marshes, in 
some places, and in others, open and exposed ; yet, notwithstanding, 
these regions are more exempt from fevers than almost any other 
portion of the State. 4 Diseases arising from malaria might be 
expected to be very prevalent in the valley of the Sacramento, 
containing, as it does, thousands of acres of land subject to annual 
overflow, and from which there is no escape for the water, except 

1 Tullock, Sickness and Mortality of British Army, 16, 45. B. 

2 Forry, op. cit. 278-9. 3 Op. cit. 704. 
4 Carpenter on Periodicity, N. 0. J. iii. 429. 



182 PNEUMONIA AND 

by the slow process of evaporation, under the rays of an intensely 
hot sun ; yet, notwithstanding this, cases of intermittent fever are 
comparatively rare in this part of the valley. A few mild cases of 
intermittent fever occurred in the neighbourhood of the city last 
spring ; but they appeared to be confined to low localities which 
are situate in the immediate vicinity of stagnant water. 1 

Dr. Tilton, in a communication to Dr. Currie, states that the 
town of Lewes, on Cape Henlopen, in the State of Delaware, is so 
salubrious, that the inhabitants are the longest-lived in the State, 
and persons affected with enlarged spleen, and obstructed viscera, 
from repeated attacks of fevers, are speedily restored to health by a 
residence there. Yet, the Cape is perfectly surrounded with marshes. 
The same thing is observed at Bombay Hook, another town of the 
same State. 2 

But such facts, and numerous instances of vessels, which, though 
filthy in the extreme, remain free from fever, upon which Dr. Dun- 
das and other opponents of the doctrine of malaria seem to attach 
so much importance, do not, true as many of them doubtless are, 
militate against the views here advocated. Neither can much be 
made out of the fact, often adduced, that the true yellow fever has sel- 
dom prevailed farther south than the Amazon Eiver, which divides 
Brazil from Guiana, though materials for decomposition, terrestrial 
and atmospheric humidity, and high temperature, exist to as great 
an extent south as north of that point ; that its proper soil is to be 
found in the West Indies, on a small portion of the coast of South, 
and a larger one of North America, and of Western and Eastern 
Africa, embracing an area which extends from the aforesaid river to 
Charleston in one direction, and from Barbadoes to Tampico in 
another — to say nothing of its appearing occasionally as low as New 
York, or even Boston, as well as in some parts of southern Eu- 
rope; that the disease, indeed, can scarcely be said to appear south 
of the equatorial line, sparing the Atlantic and Pacific coasts of 
America, south of the Amazon ; and that it seldom or never ap- 
pears in the East Indies, where, notwithstanding all that Valentin, 
Ffirth, Pugnet, Lind, Bancroft, Chervin, and many others may have 
said to the contrary, autumnal fever assumes the character of the 
bilious remittent, and not of the true typhus icterodes. 

1 Blake, On the Climate and Diseases of California, N. 0. J. ix. 510. 

2 Currie ; Hist. Account of the Climate and Diseases of the United States, 211, 218. 



AUTUMNAL FEVERS. 183 

In reference to the argument against the malarial origin of fever 
derived from the exemption from the disease in question beyond 
the limits thus assigned to it, it may be remarked that, admitting 
the statements on which it is predicated to be correct, the exemp- 
tion in question could not be used successfully to disprove the 
necessity of morbid exhalations in the production of the fever ; for, 
if it be true that such exhalations — which must exist south as they 
do at the equator and north of it — do not give rise to the disease 
beyond the limits mentioned, the opponents of malaria will have to 
explain how it happens that the causes to which they assign it, and 
which they must allow exist in as fall force on one side as on the 
other of the line, do not occasion the effect. If such causes are, from 
some unexplainable influence, incapable of producing that form of 
fever south of that line, while they occasion it in the other direc- 
tion, there is no reason why the same may not be the case with 
respect to exhalations. But we may go farther, and deny the state- 
ments respecting the absence of yellow fever south of the equator ; 
for, though it be true that in South America the disease is not of 
such frequent occurrence as in the West Indies, and on the coast 
of America at or north of the line — though in India the fever sel- 
dom, if ever, appears in its legitimate garb, there are not wanting 
facts, of the most unequivocal character, to show that yellow fever 
has made its appearance, and prevailed extensively and fatally be- 
yond the southern limits mentioned. Of course it will not be denied 
that such has often been the case on the African coast. The epi- 
demics of Sierra Leone, Ascension, Boa Yista, &c, are there to settle 
that point. Turn we to the American continent, and we shall find 
that the fever has prevailed at Guayaquil -, 1 that it has shown itself at 
Callao; 2 and that it has not spared Montevideo. 3 Nor should it be 
forgotten, that the very first epidemic of yellow fever of which we 
have the records, occurred in the southern hemisphere — at Olinda, 
in Brazil — where it is said to have exercised its baneful effects 
from 1687 to 1694 ; 4 and, agreeably to the fanciful notions of the 
importationists, to have been communicated to vessels from Siam, 

1 De la Condamine, Voyage a l'Equateur, Paris, 1751, iv. Ulloa, Voyage Historique 
de l'Amerique Meridionale, ii. 140 (1752). 

2 Leblond, Observ. sur la Fievre Jaune, 200. 

3 Humboldt, Essai Politique, iv. 503, 8v. ed. 

4 Ferreyra da Rosa, Tratado unico da constituicao pestilencial de Pernambuco, em 
Lisboa, 1691. 



184 PNEUMONIA AND 

which in their turn introduced it into Martinique. I am aware 
that doubts may be entertained as to the real icterode nature of 
that fever, and I myself am not free from misgivings on the sub- 
ject; but, admitting it to have been nothing more than a severe 
form of bilious remittent fever with typhoid tendencies, some of 
the cases observed on that memorable occasion presented the de- 
cided characters of true yellow fever, thereby showing the possi- 
bility of the occurrence in question. Since then, we learn from 
Sigaud that, during his residence at Eio, he saw five well-marked 
cases of the disease. 1 Add to this that the events of the last few 
years are of a nature to convince the most skeptical of the possi- 
bility of true yellow fever occurring in that hemisphere; for no one 
is ignorant of the fact that the fever broke out at Bahia, in Brazil, 
and soon after at Rio Janeiro, where it pursued the epidemic course 
it pursues everywhere. 

But these facts, to say nothing of the circumstance that the dis- 
ease observed by Fontana 2 and others on the East India coast, pre- 
sented the characteristic marks of yellow fever, will be sufficient to 
disprove the statements referred to, and to convince us that the 
same causes which occasion the disease on one side of the line may 
do so equally well on the other. If, therefore, we find the disease 
less apt to prevail in some places than in others, and if a like 
exemption as regards the other forms of malarial fevers is noted in 
various localities, we are not from that circumstance warranted in 
denying the febriferous power of malaria, for, on examination, it 
will be found to arise from the operation of well-known influencing 
agencies. 

The exemption may he explained in various ways. — Sometimes it is 
due to the high elevation above the level of the sea of the place so 
exempted. At another time, the effect is attributable to the ab- 
sence of a sufficiently high and long-continued atmospheric heat. 
In other instances, the circumstance is due to a very perfect and 
constant ventilation, and a very rarefied and pure character of 
atmosphere. In some instances, again, it may be explained by the 
peculiar geological character of the soil ; the quantity and the qua- 
lity of the surface-water ; or the proportion of sulphates the latter 

1 Du Climat et des Maladies du Brdzil, 258. 

2 Des maladies qui attaquent les Europe'ens dans les pays chauds, 72-3. 



AUTUMNAL FEVERS. 185 

contains in solution. Sometimes, also, it is due to the rapidity of 
the river currents, the excessive and rapid dryness of the atmosphere 
during the hot season, the existence and extensive prevalence of 
refreshing and purifying winds, and often to the degree of desicca- 
tion the surface has attained by natural or artificial means, the 
degree of cultivation to which it has been carried, and .other agencies 
of like import, as well as by the extent to which it is sheltered, 
by rich foliage and other means, from the action of the sun. So 
far as ships are concerned, the freedom from fever will often be 
found ascribable to the latitude in which they may be navigating, 
to the early period of the year in which they may be at sea, or 
otherwise employed ; or, to the absence of an epidemic constitution 
of atmosphere. 

In the examination of the subject, none of these contingencies 
should be overlooked. Experience has shown that there is an 
altitudinal range, varying in different parts and according to the 
peculiar form of the disease, beyond which, owing to the greater 
rarefaction of the air, peculiarity of temperature, or other circum- 
stances, the elimination of the febrile poison does not take place, 
or the latter is rendered inert; that a certain range and continued 
elevation of the thermometer is required for its development ; and 
that free ventilation, and strong unimpeded currents of wind are 
inimical to its morbid agency. Experience has shown in addition, 
that while, as we have seen, an argillaceous soil is prone to the 
development of fever, a region of primary formation, with a sandy, 
calcareous, arid, and sterile soil, allowing no stagnant water, and 
containing only a small proportion of organic remains, is usually 
-exempt from the disease ; that, in not a few instances, the passage 
from a fever to a healthy locality takes place within circumscribed 
boundaries, and is indicated by a difference in the geological for- 
mation of the soil ; and that, if exceptions to this occur, the ex- 
planation is easily found in the fact that the cause of the disease 
has been wafted from some pestiferous region, to a locality which, 
otherwise, would have remained unaffected ; or in the circumstance 
that the calcareous structure of the sickly spot, though naturally 
of a kind not subject to fever, is covered over, extensively or in 
spots, with a more or less thick coating of rich absorbent soil, 
possesses an argillaceous substratum, or presents depressions, in 
which water stagnates, and the process of decomposition takes 
place. Again, experience has shown that water containing a small 



186 PNEUMONIA AND 

amount of sulphates, is less injurious to health, and less prone to 
favour the formation of malaria, than that which is richer in those 
materials ; while on examination, it is found that the vegetable 
matter contained in peat moss is subcarbonized, and necessarily 
unsusceptible of decomposition ; that such moss, as already stated, 
is known to possess peculiar antiseptic qualities, which, by impart- 
ing to it the power of preserving not only trees and other vegetable 
but animal substances from putrefaction, renders it unfit to evolve 
the efficient cause of periodic fevers. 

See the remarkable contrast noticed in the relative prevalence of 
agues in New England, New Brunswick, and Nova Scotia, on the 
one hand, and on the other, in the region of the great lakes on either 
the American or British soil. This contrast, resulting from the ab- 
sence of such fevers in the former region, and its great prevalence 
in the latter finds no explanation, as Dr. Forry well remarks, in 
any difference of climate as regards temperature and moisture ; 
but the solution must be sought in the modification of climate 
arising from geological formation and the nature of soil. " Now, 
as the region of New England, as far as the St. Lawrence, with 
little exception, has a primitive formation, with a sandy, sterile 
soil, whilst that of the lakes consists of a secondary formation, 
having, not unfrequently, an alluvial superstratum, composed of 
a rich vegetable mould from three to six feet deep, it is not diffi- 
cult to deduce the correct inference. In the former, the geologi- 
cal structure is destitute of organic remains, and the little con- 
tained in the sandy soil does not find enough moisture to induce 
the necessary chemical action ; while in the latter, not only is the 
geological formation of secondary origin, but the deep, rich soil is 
sufficiently humid, when a high temperature acts upon the organic 
remains with which it abounds, for the development of the morbid 
poison called malaria." 1 

The fact that some marshy surfaces, which are supposed to 
give rise to fevers by means of the exhalations issuing from them, 
prove completely, or to a great extent, innocuous in certain sea- 
sons, and even during a succession of years, cannot be urged as 
an argument in favour of the denial of the malarial cause of fever, 
finding, as it does, a ready explanation in the absence, during those 
seasons of exemption, of the thermometrical and hygrometrical 

1 Forry, Climate of the United States, 280. 



AUTUMNAL FEVEES. 187 

conditions, which experience has taught us to regard as essential to 
the evolution of the poison, as well as, often, in the absence of that 
peculiar state of atmosphere to which the name of epidemic, con- 
stitution, or meteoration has been applied ; and the agency of which, 
in diffusing and enhancing the virulence of the cause of certain 
diseases — explain it as we may, and extraordinary as it may appear 
— it would be just as reasonable to doubt, as to doubt the existence 
of those fevers themselves. 

Elevation. — In regard to elevation — not that to which the cause 
of fever, and of course fever itself can be carried, for we shall see 
that much may be done in that way; — it is a fact of common 
notoriety that it exercises a marked influence, not only on the form 
and type of the disease, but even on its very existence ; an influ- 
ence not very dissimilar from that which, as already pointed out, is 
occasioned by geographical latitude. If fevers decreased in frequency 
in proportion as we proceed in a northern direction ; if at last we 
reach a latitude where they cease to manifest themselves; so, in like 
manner, as we ascend from the level of the sea, they are found to 
diminish in frequency till at last we arrive at a degree of elevation 
varying according to many concomitant circumstances, where 
localities which, in lower regions, would be sure to be more or less 
infested with malarial fevers may be visited and inhabited with 
entire impunity. 

We have already seen that the marshes on the summit of the 
Calabrian Mountains do not possess febriferous powers. In other 
parts of Italy, though some places, as Sezza, Norma, Sermonetto, at 
an elevation of from 230 to 300 metres, are unhealthy, Monte Mario, 
near Eome, at a height of between 130 to 150 metres (about 495 
feet), and Tivoli, at one of 208 metres (about 690 feet), are free 
from the fever which scourges the neighbouring localities. 1 Much, 
of course, will depend on the direction of the wind, the mode of 
exposure, and other local circumstances. As a general rule, accord- 
ing to Tournon, when we reach a height of from 120 to 150 metres 
above the level of the plain, we enter the salubrious zone, 2 whatever 
may be the nature of the localities so situate. Monfalcon (p. 75) 
agrees with those who fix the limits at four or five hundred metres 

1 Tournon, Etudes Statistiques sur Rome, i. 209 ; Julia, 25, 26 ; Breyslack, Voy. 
dans la Campanie, ii. 

2 Tournon, ibid. 209; Carriere, 314 (note). 



188 PNEUMONIA AND 

— 1,167 to 1,667 feet. The Italians are well aware of this advan- 
tage of elevation ; for, according to them, in ascending, we pass 
gradually from the aria passima to the cativa ; thence to the sospetta; 
then to the sufficiente ; to the buona • and, finally, to the fina o 
ottima. 

The mountains of Corsica, 1 of Tyrol, 2 and of Switzerland, 3 are 
in like manner exempt from the same diseases, while the valleys 
and low lands are severely afflicted ; and yet, in the former, sources 
of marsh exhalations are not wanting. Maroon Town and Phoenix 
Park (Jamaica), each at a height of 2,000 feet, are remarkable for 
healthiness. 4 The inner Cabrite and the outer Cabrite — the first at 
430 and the latter 590 feet of elevation — have also been found very 
healthy. In Grenada, Morne Cardigan, 500 feet, and Kichmond 
Heights 730 feet, are not sickly. 5 Mount Demoulin, near Eoseau, in 
the Island of Dominica, at an elevation of 1,500 feet, has been inva- 
riably free from yellow fever. 6 The same immunity has been 
noticed in St. Domingo, in the mountainous parts of which, what- 
ever be the condition of the soil, this disease does not prevail. 7 The 
same fever has made its appearance, in 1812, and other occasions, 
on Brimstone Hill, St. Christopher, at an elevation of 700 feet, 8 and 
four times (1817, 1825, 1827, and 1831) at Stoney Hill, Jamaica, 
the height of which is 1,360 feet. 9 But these are generally healthy, 
and free from ordinary fever. In Mexico, according to Humboldt, 
the farm of the Encero, the height of which is 928 metres, forms 
the superior limits of the vomito, 10 and the same disease scarcely 
ever passes beyond the ridge of mountains that separate La Guayra 
from the valley of Caraccas. 11 

Major Tullock, while remarking that mere elevation to a height 
of 600 or 700 feet, does not secure a healthy position, as demon- 
strated by the instances of Fort St. George, at Toboga, of Morne 
Fortune, at St. Lucia, and of Mount Bruce, at Dominica, where, 
indeed, the results were the reverse of salutary, adds that it is 
proved beyond a doubt that, "at an elevation of 2,000 or 2,500 feet, 

1 Heurteloup, Tr. de Giannini, i. 269 (note). 

2 Zimmerman, de l'Experience, i. 106. 

3 Bosquillon, Tr. de Cullen, i. 76. 

4 Imray, Ed. J. hex. 260 ; Arnold, 192 ; Statist. Rept. of Sickness, &c. 63. 

5 Hunter, 307. 6 Imray, Edinb. J. lxiv. 340 ; Lind, 224. 

7 Bally, 326, 335; Dalmas, 64, 65; Gilbert, 102. 

8 R. Jackson, Sketch, i. 16. 9 Tullock's Rept. 59. 

10 Nouvelle Espagne, 771. u Humboldt, Pers. Nar. iii. 392-5. 



AUTUMNAL FEVERS. 189 

they are likely to be wholly exempt from that disease, or to 
encounter it in so very modified a form, that the mortality from all 
causes will not, on the average of a series of years, materially 
exceed that to which an equal number of European troops would 
be subject in the capital of their native country." 1 Bally also gives 
to the yellow fever an analogous altitudinal limit. 2 

In this county, the yellow fever is never known to prevail in 
very high situations, whatever may be the condition of the localities. 
As regards ordinary autumnal fever, the exemption is noticed from 
one end of the continent to the other. The city of Mexico, and 
the surrounding country, is never visited by the fever which 
scourges the land near the level of the sea. "The inhabitants 
among the sources of the Kenawba and Tennessee Eivers, on the 
Appalachian Mountains, at a medium elevation of nearly three 
thousand feet, are almost exempt, while those who occupy the 
valleys under the same parallels are affected ; and farther north, 
at half that elevation, where the Alleghany and Genesee Eivers 
have their sources, the disease is almost unknown, while on the 
shores of Lake Ontario, directly north, it prevails. Finally, the 
constantly increasing elevation of the desert to the west of the 
Mississippi is, no doubt, one cause of the disappearance of the 
fever under the same parallels in which it prevails on the banks 
of that river." 3 

Assilini, in his treatise on the Plague, remarks that, during all the 
epidemic fevers, and even the most dreadful plagues, there have 
been, in those cities and provinces where such diseases were raging, 
some healthy spots. "The citadel of Cairo presents," he states, "one 
example. It has been observed that the inhabitants of this fort 
and its environs have always escaped from the plague, even from 
that of the year 1791. If the inhabitants of this fort, in spite of 
their daily intercourse with those of the city, were preserved from 
this disease, it must be because the damp and infected air which 
had destroyed the health of the inhabitants of lower Cairo, had not 
sufficient elevation to reach to the highest part of the citadel and 
its environs, and consequently could not impair the health of those 
who lived there." (Pp. 58-9.) Just as probable is it that the exha- 
lations giving rise to that form of fever cannot be eliminated in 
that high and salubrious situation. In the year 1835, when the 

1 Op. cit. 103. 2 Typhus d'Amerique, 325, 6. 3 Drake, 715. 



190 PNEUMONIA AND 

disease committed such ravages in the same city, the citadel was 
again preserved, as well also as the village of Loumeldik, the situa- 
tion of which is sufficiently high to overlook the whole Peninsula. 1 
As regards the cause of the diminution and cessation of miasmal 
fevers at certain degrees of terrestrial altitude, it will be unnecessary 
to enter at any length in this place. The effect may be due in 
some measure to a diminished atmospheric pressure. But many 
circumstances induce the belief that the explanation must be sought 
principally in the diminished or low temperature which forms a 
characteristic of high localities; for it is a well-ascertained fact 
that, except in cases where the soil expands into extensive plains, 
and the irradiation of caloric which ensues counterbalances the 
cold incident to such positions, the elevation of the soil is invari- 
ably attended by a diminution of temperature. It has been com- 
puted that a perpendicular elevation of from three hundred to four 
hundred feet produces a decrease of heat equal to that attendant on 
an approach of one or two degrees toward the poles. Fuster, in his 
highly interesting work on the Diseases of France, calls attention to 
the fact that, under the line, a degree of cold is generally found 
to correspond to an elevation of 219 metres or 730 feet ; in the 
temperate zone, to 174 metres or 580 feet; in winter, to 70 metres 
or 233 \ feet less than in summer; and at seven o'clock of the morn- 
ing to 60 metres or 200 feet less than at five o'clock of the afternoon. 
In Paris, during the hot season, when the ground is nearly as much 
heated as it is in tropical regions, it was ascertained by Gray-Lussac, 
at the time of his aerostatic ascension, that at a height of 7,000 
metres, or 23,333J feet, a degree of cold corresponded to an eleva- 
tion of only 174 metres or 500 feet. 2 

Supposing these statements to be correct, it follows, as M. Boudin 
remarks, that, at the 46th degree of N. latitude, an elevation of 
2,000 metres or 6,666f feet, would give us the temperature of Lapo- 
nia. 3 With this before us, we can understand that febrile complaints, 
which are found to diminish in point of frequency as we proceed in a 
northerly direction, and finally disappear when we reach a certain 
point, will equally cease to exist at a given height above the level 
of the sea. 

1 Clot Bey, De la Peste, 223 ; Brayer, Neuf Annees a Constantinople, i. 357. 

2 Fuster, Des maladies de la France dans leurs rapports avec les saisons, &c. 83. 

3 Op. cit. 35. 



AUTUMNAL FEVERS. 191 

This will appear the more natural when we take into considera- 
tion the effect of temperature on the production and dissemination 
of these complaints, for, as Dr. Forry has well remarked, the meteor- 
ology of heat is intimately connected with the laws of malarial dis- 
eases in the relation of cause and effect. 1 

Degree of heat. — Experience teaches us that, although heat alone 
cannot be viewed as the efficient cause of autumnal or periodic 
fevers, a certain range and permanence of elevation of temperature 
are necessary to insure the development of the disease ; and that, 
unless this obtains, the latter does not make its appearance, how- 
ever favourable in appearance the soil and localities may be to the 
production of morbid exhalations. It has already been seen that 
fever rarely prevails in cold climates, and then only during hot 
weather; that in temperate latitudes it never shows itself in the 
winter season, but breaks out towards the middle of summer ; that 
a temperature of sixty degrees is necessary for its manifestation ; 
that it will not prevail as an epidemic where the temperature of 
that season falls below 65°, and that it disappears on the accession 
of frost. 2 The necessity of a still higher temperature, continued 
during a certain time, has been found requisite to insure the pro- 
duction of true yellow fever ; for, whatever be the condition of the 
localities where it generally breaks out and prevails, the occurrence 
fails unless the thermometer marks a high degree of heat, and con- 
tinues to give a certain average during weeks or months. We all 
know the average summer temperature of the tropics — the proper 
soil of the disease. Nowhere, whether in Africa, the "West Indies, or 
on the South American coast, does it fall under 80°. In our Southern 
States, where the winter season is characterized by cool weather, the 
summer heat approaches to that of tropical regions ; and when the 
fever, which, as is known, is not there of annual occurrence, breaks 
out, it does so generally in seasons when the range of the thermo- 
meter equals that of the West Indies and Yera Cruz. Such has been 
the case at New Orleans, Mobile, Natchez, Charleston, and Savannah. 3 

» Climate of U. S. 277. 2 Drake, 715. 

3 Gros, 5 ; Thomas, 62, 78, 109 ; Barton, Fev. of N. 0. in 1833, pp. 4, 5; Baxter, Med. 
Repository, xxi. 3; Rept. on Fever at N. 0. in 1819, 6, ib. for 1839, Jourti. of Med. 
Soc. 156 ; ib. for Fev. of 1820, for 4 ; Shecut Med. Essay, 77, 93, 103 ; Tooley, Fever 
of Natchez, in 1823, p. 7 ; Girardin, 51 ; Merrill, N. A. J. ii. 237, ib. Med. and Phys. 
Journ. ix. 233; Monnett, 11, 35; Chabert, 23; Periee, Med. and Pliys. J. iii. 17; 



192 PNEUMONIA AND 

Nor is this less the case in our Middle States, where the summer 
temperature likewise approximates closely to that of the torrid 
zone, for there the fever has scarcely ever appeared, unless the 
mean temperature has reached or approached to 80°. This has been 
observed at Norfolk, Baltimore, New York, Providence, and Bos- 
ton. It was also early pointed out in this city, and has been noticed 
in all the epidemics that have prevailed here from 1699, to the pre- 
sent year. All this the reader will easily find by referring to the 
writings of Valentin, 1 Whitehead and Selden, 2 Archer, 3 Dalmas, 4 
Miller, 5 Seaman, 6 Bayley, 7 Townsend, 8 Drysdale, 9 Wheaton, 10 
Brown, 11 Cadwallader Evans, 12 Caldwell, 13 Deveze, 14 Chapman, 15 
Folwell, 16 Ffirth, 17 Rush, 18 and others. 19 Sir Gilbert Blane has 
called attention to the same fact, in relation to the yellow fever of 
Europe, 20 and his observations are fully confirmed by those of every 
writer on the epidemics of Cadiz, Barcelona, Gibraltar, Leghorn, 
Xeres, Seville, Carthagena, Marseilles, &c, where the appearance 
and prevalence of the fever has, as elsewhere, invariably been asso- 
ciated with a mean temperature, in every way equal to that observed 
during sickly seasons within the tropics. 21 

Cartwright, Med. Recorder, ix. 6 ; Dickson, Med. and Phys. J. iii. 251 ; ib. Eclectic 
J. iv. 112; Simon's Address, 3; ib. Rept. 10; Chalmers, Climate of S. C. i. 164; Moul- 
trie, French Translation, 8 ; Ramsay, Hist, of S. C. ii. 83 ; Lining, Edinb. Essays, ii. 
409 ; Dupre, Am. J. (N. S.) ii. 382 ; Waring, 20; Tucker, Barton's J. ii. 22 ; Fenner, 
N. 0. J. Sept. 1848, p. 194. 

1 Fievre Jaune, 85, 6. 2 Med. Repos. iv. 129. 

3 Med. Recorder, v. 61. 4 Fievre Jaune, 30, 38. 

5 Works, 118, 119, 433. 6 Webster's Collection, 1, 2. 

7 Fever of N. Y. in 1795, p. 124. 8 Fever of N. Y. in 1822, p. 259. 

9 Med. Museum, i. 31. ,0 Med. Repos. x. 329. 

11 Med. Repos. ii. 360, 467; Treatise on Fever of Boston, in 1798, p. 26. 

12 Ecclect. Repertory, vii. 425 ; and Med. Recorder, i. 139. 

13 Med. Mem. (1826), 87. M Op. cit. 116. 

15 Med. and Phys. Journ. viii. 356. J6 Fev. of Phila. in 1798, pp. 13-22 ; ib. 

1797, p. 48. 

17 Treatise on Mai. Fev. 21, 2, 3, 4. 

18 Works, iii. 41, 49, 120. 

19 Emlen, N. A. Journ. v. 329; S. Jackson, Fev. of 1820, pp. 12, 13; Watts, N.Y. Med. 
Reg. 30; Carey, Fever of 1793, Meteor. Tables; Med. Repos. ii. 406; Currie, Fever 
of 1793, p. 15 ; Smith, on Epidemics, 78; Currie, Fevers of 1798, pp. 2, 4, 5, 37, 8 ; 
76. 1798, p. 29 ; Hill, Fevers of Wilmington, N. C. Recorder, v. 87; Hardie, Fever of 
N. Y. in 1798, end of vol. ; Revere, Fever of Baltimore, in 1819, Recorder, iii. 217. 

20 Dissertations, ii. 155. 

21 Fellows, 33, 244, 565 ; Amiel, in Johnson, Trop. Climates, 250 ; Pariset, Fievre de 
Barcelone, 12, 185; Robert, Guide. Sanit. 110, 111, 742; O'Halloran, 122; Burnett, 
Fever of Medit. 205; Tommasini, sect. 161, ii. 483; Bally, 323; Rayer, 23; Roch- 



AUTUMNAL FEVERS. 193 

The necessity of a high degree of atmospheric heat for the extri- 
cation or production of the febrile cause out of the materials from 
which it is usually found to be obtained, is every day illustrated in 
Italy, for there, as elsewhere, marshes or collections of putrescent 
substances, which are, to all external appearances, in a fit state to 
evolve the poison, and even to emit vaporous effluvia offensive to 
the olfactory nerves, remain innocuous so long as the thermometer 
does not reach a high point. " Thus," says Thouvenelle, " in the 
marshy lagunes of Venice, during the very low tides of January 
and February, the air of the capital is infected with an hepatic and 
miry odour during ebb-tide. Nothing is seen at the bottom of 
the canals of the city, and all around the latter, but fetid and black 
mud. And yet, notwithstanding, the health of the inhabitants was 
not seen to be affected in a way to justify its being attributed to 
that cause." 1 

" If the temperature," says Dr. McCormack, "prove habitually 
below 80°, whatever be the exuberance of vegetation or the quan- 
tity of marsh land, malaria is never generated. Malaria does not 
subsist in the north of England, nor in Scotland, nor in Ireland, 
nor in Sweden, Denmark, or Norway, nor in the colder parts of 
Europe, Asia, North and South America; in fine, nowhere, so long 
as the temperature — a few degrees more or less — keeps below 80°. 
Let it rise above this, and thereupon we have malaria, and periodic 
fever in all its forms." " If the summer temperature in Ireland 
ranged habitually from 80° to 100°, paludal fever would prove 
even more frequent and destructive than ever continued fever was 
known to be. In point of fact, some low-lying ranges of the uncul- 
tivated land near Dublin and Belfast, were said, during hot sum- 
mers, thirty or forty years ago, to be productive of malaria ; but 
there is nothing of the kind now, and intermitting fever is rarely 
witnessed in Ireland, except in persons who have been abroad, or 
the poor serfs who go to reap the harvests in the marshes of Essex 
and Lincolnshire." 2 

oux, 110, 11] ; Audouard, 44; Arejula, 132, 133, 134; Lind, 91; Berthe, 154, 324; 
Vance in Pym, 64 ; Tullock, Rep. on Sickness of Troops in Medit. 4, D. ; Caisergue's, 
18, 19; Pierquin, Trad, de Mem. &c. sur la F. Jaime de Barcelonne, 40; Blin, Trad, 
du Rapport sur la Mai. Epid. &c. Cadiz, 1800, p. 4 ; Doughty, Observ. on Yellow 
Fever, 180, &c. 

1 Climat de l'ltalie, iv. 212. 

2 McCormack on Malaria, Edinb. Med. J. Iv. 372. 

13 



194 PNEUMONIA AND 

Sheltering from the action of the sun. — Much of the baneful effects 
of marshes and fresh surfaces are preveuted, especially in temperate 
latitudes, by their being sheltered from the action of the sun. Mr. 
Fleurian de Belle vue, in a communication to the Academy of 
Sciences, shows, as the result of his observations in France and 
southern Italy, that when marshes are well furnished with water, 
and covered with trees planted very close to each other on the banks 
and causeways, so as to shelter them from the action of the sun, 
they are as innocuous during summer as the best soil, well dried, 
and in full cultivation. The mortality, in such localities, is 1 to 42, 
or 46 ; while, in other places, where marshes are dried, and the soil 
of these is argillaceous, compact, horizontal, and divested of trees — 
as, for example, in natural prairies that are very dry during sum- 
mer, and on which rain water remains stagnant some days, the loss 
is 1 in 25, 20, or even 16. This is conformable to the results of 
experience in this and many other countries, where it is found that 
marshes, or neAV soil, which are completely sheltered from solar 
heat by a full growth of woods and thick foliage, may remain per- 
fectly or comparatively healthy. It has long been found, as we 
shall have occasion to show more clearly as we proceed, that in the 
midst of compact forests, the sun never reaches the surface, its rays 
being fully intercepted by a thick growth of trees, cj^press, juniper, 
magnolia, reecls, &c. In such places, however apparently calculated 
they appear to furnish morbid exhalations, intermittents, nevertheless, 
do not prevail. Dr. Williamson, who, like many others, has called 
attention to this fact, remarks that families who live in the Dismal 
Swamp of North Carolina, employed in making shingles, without a 
perch of clear or dry ground, enjoy more health than people who 
live on their new plantations, near the river or swamps. 1 That the 
effect is justly attributable to the cause mentioned, may be inferred 
from the fact that, on the removal of the means of shelter, fever 
makes its appearance. But of this more hereafter. 

Free ventilation. — Again, experience has shown that free ventila- 
tion, and strong unimpeded currents of wind, are inimical to the 
generation of malarial exhalations, consequently to the production 
of fever ; that where the wind blows freely and strongly, or finds 
no obstacles from surrounding objects, and where, in consequence, 

1 Hist of North Carolina, ii. 192. 



AUTUMNAL FEVERS. 195 

the air is quickly renewed, t localities which otherwise might be 
expected to be fruitful sources of fever, may be visited or inhabited 
with impunity, while similar places become insalubrious, if the air 
is stagnant. " Calms," says Dr. Drake, " permit the exhalations 
from foul localities to accumulate in the atmosphere which rests 
over them ; but all winds operate to disperse and dilute them with 
purer air ; in doing which they may promote the salubrity of one 
spot and diminish that of another." 1 It is of daily observation, 
especially in warm climates, and in hot seasons in temperate coun- 
tries, or in localities subject to periodic fevers, that these assume a 
severe character, and even spread epidemically when the air has 
long been undisturbed by winds or thunderstorms. The late Pro- 
fessor Halle, long one of the magnates of the Medical School of 
Paris, in an able report on the condition of the River Bievre, near 
that city, pointed out the fact that the pernicious effects of the fetid 
exhalations issuing from the banks of that river, are harmless in 
situations where the atmosphere circulates freely and is renewed 
by strong and unimpeded currents. 2 This injurious effect of a 
stagnant state of the atmosphere was noticed as early as the 
time of Hippocrates, who alludes to it in the third book of his 
epidemics, and has been dwelled upon, on just grounds, by many 
writers on the fevers of the "West Indies, of South America, this 
country, and Europe. 3 

In many parts of country — India, and other hot regions, for 
example — fever prevails widely where it should least be expected ; 
on high mountains. But these are covered with lofty woods, or 
thick jungles. There the surface of the earth is constantly strewed, 
particularly in autumn, with organic remains, and kept moist by 
rain or dews. The lower stratum becomes impregnated with emu via, 

1 Op. cit. 587. z Mem. de la Societe de Medecine, x. 78. 

3 Le Blond, 7, 16, 19, 106; Clark on Long Voyages, i. 5; Imray, Edinb. J. liii. 
92; Lempriere, i. 17; Eufz, 31, 82; Eep. on Sickness, &c. of Br. A. 102; Merrill, 
Med. and Phys. J. is. 233; Villerme, an. d'Hyg. xi. 319; Celle, Hyg. des Pays 
Chauds, 20 ; Baglivi, Op. Om. 81 ; N. Y. Med. Repos. ii. 403 ; Vincent, Fievre J. 7 ; 
Ralph, Edinb. Med.-Chir. Trans, ii. 55, 60 ; Copland, End. Influences, Diet. i. 759, 
Am. ed. ; J. Clark on Y. F. 49, 56, 57; Monfalcon, 92; Deveze, 134; Caillot, 108; 
Van Swieten, v. 160 ; Hancock, 78 ; Diemerbroeck, cap. 3, 5 ; Caldwell, Med. Repos. 
vii. 144,5; Thouvenelle, op. cit. i. 180; Jameson, Dublin Med. J. N. S. xvi. 332; 
Wilson, Treatise on Fevers, i 79, Am. ed. ; Zimmerman on Experience, ii. 391 ; 
Ainslie, Smith, and Christy, Fev. of Coimbatori, 60-77 ; Rep. of London Gen. Board 
of Health on Sewer Water, &c. 8 ; Dundas, Sketches of Brazil, 245, 346. 



196 PNEUMONIA AND 

which are seldom agitated by breezes, or rarefied by the sun's rays. 
Dr. James Johnson, who has noticed this, remarks that among the 
lofty forests and impenetrable jungles of Ceylon, fever prevails ex- 
tensively. " It is under the branches of these shrubs," (in Ceylon,) 
says Lord Valentin, " that the fatal jungle fever is probably gene- 
rated. Not a breath of air can pass through ; and the confined ex- 
halations from black vegetable mud, acquire a highly deleterious 
quality, affecting both the air and the water." 1 

Many of the bays and inlets in the West Indies, while they derive 
their security, also derive their unwholesome air through the agency 
of the hills surrounding them, which gives them an atmosphere little 
agitated by winds, and in which, consequently, the morbid exhala- 
tions from the marshes which are situate along their banks, may 
well be supposed to continue suspended, accumulate, concentrated 
by heat, and become infinitely more pernicious. Dr. Chisholm, 
among others, while calling attention to this fact, and to the cor- 
rectness of the explanation, adduces several cases in illustration. 
The French have, therefore, not inappropriately denominated these 
situations " lieux etouffes." 2 After mentioning that the state of the 
atmosphere during September, and the first two weeks of October, 
favoured the accumulation of the miasmata in this city during the 
memorable epidemic of 1793, Dr. Eush remarks, that the register 
of the weather shows how little the air was agitated by winds 
during the above time. " In vain," he says, " were the changes in 
the moon expected to alter the state of the air. The light of the 
morning mocked the hopes that were raised by " a cloudy sky in 
the evening." He very truly observes that, " however inoffensive 
uniform heat, when agitated by gentle breezes may be, there is no 
record of a dry, warm, and stagnating air having existed for a 
length of time without producing disease." 3 

Indeed, all regular and fresh currents of air have the effect of 
sustaining the healthiness of malarious localities, which, in their 
absence, would be more or less the seat of febrile complaints. In 
this country, cases in point might be gathered without the least 
difficulty as regards common periodic fever ; and every physician 
among us knows full well — for the fact is proverbial — that the 
yellow fever usually breaks out and is most rife in places noted for 

1 Travels, ii. 

2 Manual of the Climate, &c. of Tropical Countries, &c. 20. 
s Works, iii. 86, 87. 



AUTUMNAL FEVERS. 197 

want of due ventilation, while it requires but a slight acquaintance 
with medical literature to know, that the same observation has 
been made in respect to this disease everywhere, and that a similar 
remark is applicable to the oriental plague. In all places, they pre- 
vail and are most rife and malignant in narrow, close streets and 
alleys, and the poisons to which they are due, if formed, are soon 
dissipated and rendered inert in open and well-aired situations. 

It may be affirmed, without much fear of error, that it is through 
the agency of the trade-wind alone, which blows almost constantly 
from east to west, that the greater part of the West Indies is ren- 
dered habitable. When this purifying influence is withheld, either 
through the circumstances of season, or when it cannot be made to 
sweep the land on account of the intervention of high hills, as is 
the case on the leeward shore of a portion of Ghiadaloupe, Mar- 
tinique, and other islands, the consequences are most fatal. 1 Every 
one must know that, in tropical regions generally, localities situate 
in the midst of extensive forests and deep valleys, are, in general, 
very unhealthy. In the woods, the wind is felt only by the tops 
of the trees, and it not unfrequently happens that, while the former 
blows with sufficient violence to break the upper parts of heavy 
trees, scarcely a breath of air is felt on the surface below. " We 
cannot form an idea," says M. Celle, 2 " of the fetid odour which 
exhales everywhere in some of those extensive and damp forests. 
Scarcely can the sun force its way through the thick foliage; and, 
when it chances to shine through some opening, the luminous 
column is almost opaque from the large admixture of vapour and 
miasmatic effluvia with the atmospheric air. At night, the exhala- 
tions increase, and combine with those of the preceding day ; for 
the wind here never replaces the mephitic by a pure air. In the 
hot season of tropical regions the exhalations attain the maximum 
of intensity. In this season, too, we find the foliage thickest, and 
best calculated to prevent the free passage of the wind. Hence, the 
inhabitants of the forests are then annually decimated by malarial 
fevers. The same thing occurs in deep valleys, where the winds 
do not penetrate beyond the superior strata of the atmosphere, and 
cannot, therefore, renew the inferior ones. Nothing but violent 
storms, accompanied by heavy rains, can disturb and renew the 

1 Ferguson, Notes and Recollections, 201. 

2 Hygiene Pratique des Pays Chauds, 20-23. 



198 PNEUMONIA AND 

heavy and impure atmosphere. Hence, the soil of the valleys, 
when not marshy, is healthier in the rainy and stormy season than 
in April, May, and June, when the predominant winds of the sea- 
son begin to decline in force, and the air becomes cloudy and calm. 
As the counterpart of this, I might call attention to the complete 
or comparative innocuoasness of marshy localities exposed to fre- 
quent and strong currents of air ; and also to the circumstance that 
the exemption from fever of elevated positions appears evidently 
due, in great measure, to the free and unimpeded ventilation which 
there prevails. But this would lead us too far. 

Humidity of the soil. — After all that has been said in the preced- 
ing pages relative to the share of agency exercised by terrestrial 
humidity in the production of autumnal fever; of the absence of 
these when the earth and the dead organic substances by which it 
may happen to be covered is completely and thoroughly dried; of 
the outbreak of sickness on the reoccurrence of rain, or of a tempo- 
rary overflow, by which a certain degree of moisture is furnished ; 
and of the absence or cessation of the disease where the moisture 
is — from what cause soever — in excess, it is unnecessary to point 
out, in any detail, the influence which the quantity of surface water 
exercises in modifying the degree of unhealthiness of marshy sur- 
faces, and regular morasses or swamps. Enough has been adduced 
to show that the innocuousness of these, on which the opponents of 
malaria have dwelt with so much complacency, is sometimes due 
to the circumstance that such localities are so desiccated as no 
longer to be the source of morbid exhalation; and much more fre- 
quently to their being deluged with water, and so completely 
covered over that the organic matters subject to decomposition are 
thoroughly soaked, or effectually shielded from the action of the 
sun. Some marshes are often, or even generally in that condition. 
Others cease to be the source of infection after heavy showers of 
rain, or during the height of the rainy season, or immediately after 
a freshet ; and examples are not wanting, in this country and else- 
where, to show that marshy surfaces that are periodically covered 
under the influence of the rise and fall of the tides, are seldom the 
source of febrile exhalations. 

The foregoing facts will sro far to account for the circumstance of 
the poison contended for not being generated, or if generated not 
being detrimental to salubrity under all conditions of soil, tempera- 



AUTUMNAL FEVERS. 199 

ture, &c. They show that the cause of periodic fevers requires for 
its development, besides particular materials to be acted upon by 
external influences, and which abound in certain geological forma- 
tions and soils of particular kinds, or which are at times collected 
on the surface of the earth, accidentally or otherwise, a certain de- 
gree and continuance of atmospheric heat, and a certain amount of 
terrestrial humidity — neither too much nor too little ; a complete 
saturation and complete desiccation of the soil or its contents, 
being alike inimical to the manifestation of the effects to which, 
that cause gives origin. 

But these facts, and many others that precede, do more. They 
lend a powerful support to the opinion which ascribes fever to the 
agency of a gaseous poison ; for they tend to connect this febrile 
principle with the usual products of the decomposition of organic 
materials, showing, as they do, that this principle or poison requires 
for its generation the action of the very same agencies which are 
necessary for that decomposition. Precisely as takes place relative 
to the febrile cause, ordinary decomposition of organic matter 
requires a more or less prolonged continuance and a certain degree 
of atmospheric heat. Equally necessary is it that there should be 
a certain amount of moisture. Similarly true is it that an excess 
of the latter prevents or arrests decomposition ; and that a total 
absence of it will have the same effect. Like the febrile cause, the 
putrefactive change is promoted by a calm and close state of the 
atmosphere, and retarded, prevented, or modified by free ventila- 
tion and elevated situations. Xow, when we find the cause of 
fever requiring for its development the action of the very agencies 
which are necessary to insure the development of the gaseous pro- 
ducts of decomposition — when we find that without these agencies, 
applied in certain proportions, neither those gaseous products nor 
the efficient cause of fever will manifest themselves ; and that in 
all instances in which the latter is produced, as shown by the 
occurrence of fever, materials capable, when acted upon by the 
agencies in question, of giving rise to the evolvement of the gaseous 
products of decomposition — organic matter in various conditions 
and states of modification exist ; and that the total absence of those 
materials — whatsoever be the desrree of heat, and of terrestrial and 
atmospheric moisture — carries along with it an absence of fever, 
we can have no reason to doubt the propriety of admitting that 
the cause of the disease bears a close analogy to the aforesaid 



200 PNEUMONIA AND AUTUMNAL FEVERS. 

gaseous products ; and that if in regard to the former, heat, hu- 
midity, and other agencies, acting in given proportions and in 
concert, on animal or vegetable matters, give rise to the evolve- 
ment of certain gaseous substances, the febrile poison, which in like 
manner requires for its development the action of the same agencies, 
as also the existence of kindred organic matter, must necessarily 
consist also of some modification of a similar kind of gaseous 
substance. 



CHAPTER III. 

EXISTENCE AND MOEBID AGENCY OF MALARIA, 
CONTINUED. 

Occurrences on shipboard prove the agency of malaria. — The medical 
literature of Europe and this country abounds in facts of a nature 
well calculated to establish, in a satisfactory manner, the existence 
and morbific agency of malaria ; and in the presence of which it is 
difficult to conceive how any observing, reflecting, and unbiased 
physician can refuse to recognize the connection as cause and 
effect between that poison and fever. When they venture on the 
denial of that connection, the opponents of the malarial origin of 
autumnal fevers must forget, for we cannot suppose them ignorant 
of, the eventful occurrences on board of the United States ships 
General Greene, Macedonia, Peacock, Hornet, and Enterprise ; of the 
French ships Egerie, Messager, and Euriale; and of the English 
vessels Bann, Eden, Eclair, Iphigenia, Primrose, Dasher, Dart, Pique, 
Eegalia, Driver, Eattlesnake, Childers, and Pyramus. In each of 
these, and in many others which could be cited, malignant fever 
originated and prevailed widely, and was traced in a way not to be 
questioned, to miasmata exhaled from the contents of the holds or 
from the timbers of the vessels. 1 

In most of these cases the disease broke out in vessels that had 
sailed from, or were lying in ports, where, if it ever had prevailed it 
did not do so at the time, or had not for some or even many years 
before ; and when, therefore, it could not have been derived through 
the effect of contagion, or the influence of common atmospheric 
causes ; for these, had they produced the effect in question on in- 
dividuals on board, would not probably have spared those on shore. 
In some, the fever appeared at sea during a cruise or passage, and 

1 See an Essay on the subject by the present writer, in Am. J. of Med. Sc. for 
April, 1853. 



202 PNEUMONIA AND 

far from any contaminated spot; and in not a few instances, while 
the vessels infected were severely visited by the disease, others 
situate close by, in port or at sea, or on the same cruising ground, 
and which, had not the cause been located in the vessels themselves, 
would in all probability have been affected like the former, remained 
uninjured. That the disease in the vessels mentioned derived its 
origin from effluvia evolved on board, and not from ordinary atmo- 
spheric influences or a contagious principle, we may infer from the 
ci rcumstance that none of the sick who were landed from vessels so 
infected and received into hospital wards in various places, were 
found, in a single instance, to communicate it to those around ; no 
one from on board carried the disease on shore, while nearly every 
individual who ventured on board sooner or later was attacked. 
In many instances exposure to the effluvia issuing during the cleans- 
ing and purifying process from the hold, of ships heretofore un- 
contaminated, or very long free from the fever, after the crew had 
been dismissed, and when no one was left on board to communicate 
disease, has been, not in tropical and fever regions only, but in 
temperate climates also, the cause of the most concentrated and 
fatal form of the malady; while other individuals, who were placed 
under the influence of the same general morbid agencies as the 
former, escaped the infection by avoiding such exposure. 

Whether the latter proceed from effluvia issuing from the bilge- 
water, the timber of the ship, the filth of the hold, or the cargo, the 
existence of the cause within the precincts of the ship — particularly 
in the hold — is rendered evident not only by the circumstances 
already mentioned, but by the limited space and the particular spots 
to which it is confined at the outset, or throughout the whole dura- 
tion of the epidemic. The disease (yellow fever) usually or very 
frequently makes its appearance, and is more severe, in the vicinity 
of the pumps and main hatchway. This is exemplified by the oc- 
currences on board of the General Greene, the Macedonia, the Eattle- 
snake, the Eainbow, the Force, the Skipjack, the Ferret, the Scylla, 
the Lively, and the Isis, and is nothing more than what might have 
been expected; for there the keel is most dependent, the water 
draining from other parts is accumulated, and the heat is most 
intense. Thus, in English frigates, the first cases, and the largest 
rate of mortality, have in many instances been found to occur in 
the berths of the midshipmen and marines, which, in such vessels, are 
placed on each side of the pumps and main hatchway. We are 



AUTUMNAL FEVEKS. 203 

told by Dr. Wilson, that the subsequent progress of the disease 
depends on the trim of the vessel and the inclination of the keel 
from the horizontal position — the fever spreading in the most de- 
pendent parts. In almost all cases, the disease prevails more, and 
the risk of infection is greater, in the lower than in the upper deck. 
It is sometimes confined to one end or one side of the vessel. 
Take the following as an illustration. 

"In the Eattlesnake, the fever was first manifested near the main 
hatchway ; the marines and the midshipmen of one berth, suffered 
its earliest and most severe effects. Afterwards, it proceeded for- 
ward rapidly, but pretty regularly, till it had affected almost the 
entire ship's company ; but it did not go beyond the steerage in the 
opposite direction, no one being attacked in the gun-room except 
the purser, and I have good reason to conclude that in his case it 
was derived from the shore." "But its local origin and limited 
range of action were most strikingly exemplified in the berths of 
the midshipmen, and other officers of that class. They were placed 
exactly opposite to each other, with the pumps at equal distances 
between them. Only one gentleman was affected in the starboard 
berth, while every member of the larboard berth was laid up nearly 
at the same time. The hatch of the pump-well is opposite to, and 
within three feet of the larboard berth. The members of that berth 
were generally the junior officers of their class, and were, therefore, 
it may be said, most susceptible of the disease ; but when it is re- 
membered how extensively it prevailed, and how indiscriminately 
it attacked persons of all ages and temperaments among the ship's 
company, after every allowance is made for the greater susceptibility 
of these young gentlemen, the exemption of the others, senior only 
by a few years, is too striking and complete to be accounted for by 
their former service, or by any accidents which can reasonably be 
supposed to have affected them. It can fairly be attributed only to 
their not having been exposed to the cause of the disease with the 
same concentration of power, or permanence of operation, as the 
others ; and here the contiguity of the pump-well hatch to the lar- 
board berth cannot be overlooked." 1 

"When we bear in mind the particular condition of the vessels 
in which the yellow fever makes its appearance, as well as the 
thermometrical and other influences in connection with which it 

1 Wilson, Memoirs of West Indian Fevers, 159, 1G0. 



204 PNEUMONIA AND 

breaks out and prevails, and compare the results of those various 
circumstances with such as are obtained on land from kindred local 
conditions, under the modifying agency of the same meteorological 
influences, we shall find no valid reason for refusing to admit the 
relationship as cause and effect between the product of the decom- 
position which necessarily ensues and the disease which, affecting only 
individuals exposed to it, spares those who keep aloof. At the same 
time, we discover a satisfactory explanation of the manner in which 
these results are brought about. As the disease requires invariably 
for its production a long continuance of high atmospheric heat, and 
as it is, on that account, most generally encountered in tropical, or 
during the hot season of temperate climates, we can readily under- 
stand why it more frequently occurs on board of ships in the former. 
Besides, such vessels usually contain materials susceptible of decom- 
position, and which, when acted upon by the high temperature they 
there encounter, are soon productive of noxious exhalations. In mer- 
chant and other vessels engaged in the West India, South American, 
or African trades, the cargoes consist almost exclusively of articles 
susceptible of fermentation or putrefaction ; while the same vessels, 
as well as ships of war, are apt to be ballasted with materials alike 
liable to those injurious changes, and which, together with portions 
of articles provided for food, chips of wood, shavings, and dirt of 
all kinds that inevitably find their way — sometimes in unaccountable 
quantities — into the holds of vessels, where, meeting with more or 
less moisture, supplied by leakage, or the water used for purposes 
of cleansing or purification, or the drippings of the casks, or other 
sources, they form a mass which, under the influence of intense 
heat and a still atmosphere, becomes the source of concentrated 
miasmata. By one well versed in all matters of the kind, we are 
reminded that it is not always possible to account for the dirt and 
rubbish which may be found in the bottom of a ship. 

" Fragments of wood, vegetable substances, and dirt of all kinds, 
however, gravitate by the formation of the vessel towards the 
kelson or limbers ; where, by the heat of the climate and the 
action of the salt-water, they rapidly decay, and form a blackish 
mud, not dissimilar to that observed among the roots of mangrove 
thickets on the banks of the rivers within the influence of the 
tides ; it sometimes even acquires a consistence sufficient to block 
up the passage of the limbers. In small vessels, with a flying deck, 
there is less difficulty in accounting for the presence of foreign 



AUTUMNAL FEVEES. 205 

matters in the hold ; dust, fluids of various kinds, the sweepings and 
scrapings of the decks, and a thousand other things, will find their 
way there, notwithstanding the greatest care, both on the part of 
the officers and men, although the latter, nevertheless, are frequently 
wilfully careless in this matter." " In steam-ships, the difficulty is 
still greater, in consequence of the boilers and engines occupying a 
large portion of the floor of the hold, which cannot be got at. All 
this filth, in the concentrated state mentioned, may, and often does, 
exist in vessels, although the decks and other parts apparent to the 
eye are clean. In them, the cause of offence, though hidden, is not 
less real than in vessels differently conditioned, and proves often 
detrimental to health before it is suspected to exist. Of course, all 
foul ships are not necessarily unhealthy ; but those that escape are 
the exceptions." 1 

Nor is it less worthy of remark that the very timber of which 
vessels are constructed, especially when green or not perfectly 
seasoned, may be, and has not unfrequently been, when acted upon 
by the high temperature of tropical climates, the source of disease 
— an effect that could not be produced otherwise than through the 
morbid agency of noxious effluvia resulting from the action of heat 
on such materials. At any rate, such a condition of vessels has not 
unfrequently been associated, in hot climates, with the development 
of the most malignant form of the disease ; and, judging from what 
has been noticed on land of the effect of exhalations from kindred 
sources of infection, or at sea, from the stowage of damp green 
wood, we cannot err greatly when attributing the mischief, in the 
instances in question, to the decomposition of the ship's timbers. 
On this subject, the facts related by Dickson, "Wilson, Eochoux, and 
others, leave no doubt, or, at the very least, merit serious consider- 
ation. The unhealthiness of ships built of green timber has 
been noticed from time immemorial, and it will be found on exami- 
nation that severe epidemics have, on various occasions, been traced 
to the stowage of a quantity of green wood in the hold of vessels. 
This was strikingly the case in the English war-ship Eegalia, for the 
medical account of which we are indebted to Dr. Ferguson, 2 and in 
the French brig Messager, referred to by Dr. Eochoux. 3 

We all know, also, how offensive the bilge- water becomes from 

1 Bryson, 223. 2 Medico-Cliir. Trans, viii. 108. 

3 Recherches sur les Differentes Maladies qu'on Appelle Fievre Jaune, 61. 



206 PNEUMONIA AND 

admixture with the filth of the vessel ; or the great tendency that 
the water, which finds its way by leakage or otherwise into the 
hold, has of being decomposed ; sometimes owing to its original 
impure state, at others, to its combination with the fresh-water pro- 
ceeding from the drippings of the casks, &c. It is not to be denied 
that such a condition of the bilge-water is not necessarily connected 
with the appearance of disease on board of ships; cases having 
been adduced in which the foulest and most offensive water has 
proved innocuous ; while disease has raged where the odour was 
hardly, if at all, perceptible. But such cases, which find their pro- 
totypes on land, where localities noted for filthy pools escape, and 
where the appearance of malarial fevers is sometimes connected 
with an apparently pure condition of the water partially covering 
marshy swamps, or with an absence of mud or filth, are not fre- 
quently met Avith in fever seasons and latitudes. More generally 
the reverse takes place; and even were this not the case, the appear- 
ance of the disease may still be due to internal miasmata issuing 
from other sources of infection existing on board ; or, again, the 
water, though completely or almost inodorous, clear, and apparently 
pure, may nevertheless contain in solution those particles of 
poisonous matter which produces the fever. Nor does it neces- 
sarily follow, as some writers seem to imagine, 1 that the healthiness 
of foul ships in southern or other latitudes disproves the opinion 
of the connection as cause and effect between exhalations from 
sources of organic decomposition and fever. Of course, all foul 
ships are not necessarily unhealthy — all vessels containing vegetable 
and other matters in a state of incipient or decided decomposition, 
lying in southern ports or navigating southern waters, even in 
warm weather, are not all expected to suffer from fever. For, 
besides that, in good logic, a negation can go but little way in 
disproving the many well-authenticated facts we possess, in favour of 
a different conclusion, sources of vegetable and other decomposition 
on board of ships, are under the control of some of the same 
agencies, which, as we have seen, modify the effects of like sources 
of contamination on land. They require, before they can generate 
fever, to be acted upon by high atmospherical heat ; that this heat 
should continue a certain length of time ; that the season should 
be that in which the fever usually prevails; and that there should 

1 Memphis Med. Recorder, ii. 



AUTUMNAL FEVEKS. 207 

exist a suitable epidemic constitution of the atmosphere. Remove 
all these contingencies, and foul ships will generally be found to 
remain healthy. In the contrary case, those that escape are, as Dr. 
Bryson has remarked, the exceptions. 

Be this as it may, the connection as cause and effect between 
sources of miasmal effluvia and fever, is conclusively established 
by the example of those vessels in which the spread of the yellow 
fever was arrested, even in tropical climates, or during the hot 
season of temperate regions, by a resort to a thorough process of 
expurgation. In the Dart, Pyramus, Dasher, and Regalia, the 
history of which has been referred to in detail elsewhere, 1 the fever 
was arrested. In reference to the first-named of those vessels, Dr. 
Dickson remarks: "So many people were taken ill, after going on 
board this vessel, lying guardship at Barbadoes, that it was difficult 
to account for it, except on the principle of contagion, until the 
peculiar construction of the ship, viz. her being divided into com- 
partments below, so as to prevent the circulation of air and the 
stowage of the water in bulk, were adverted to, and on examining 
the large tanks or cisterns, their bottoms were found covered with 
an offensive slimy mud or deposition." 2 On the removal of some 
of these causes, the knocking down of the bulkheads, and the 
cleansing out of the cisterns, the fever was put a stop to. 

On opening the hold of the Pyramus, the effluvia which issued 
surpassed anything Dr. Hartle had ever witnessed, and affected every 
one exposed to its influence. The quantity of filth which was taken 
out was sufficient to fill four large mud-boats, consisting of shavings 
mixed with coal-tar and the water ; which, in consequence of the 
choking of the pumps, had accumulated under the limber -planks. 
All the cases which occurred during the process of expurgation 
were easily traced to exposure to this bog ; and Dr. Hartle very 
justly refuses to refer the disease to the influence of English Harbour, 
inasmuch as other ships of the squadron that lay much longer there 
escaped the infection. It may not be amiss to remark that the sick 
of this ship were landed and placed in the capstern of Antigua 
dock-yard on the 15th of January ; that between that day and "the 
30th, only eighteen cases occurred; but that on the 31st, six fresh 
attacks were added to the list, and the disease again appeared with 
increased violence and malignity." Dr. Hartle adds: "This sadden 

1 Am. Journ. April, 1853. 2 Kept, in Bancroft's Sequel, 208, 9. 



208 PNEUMONIA AND 

reappearance and violence of the disease induced me to believe that 
the people had some communication with the ship, which was then 
undergoing a general expurgation. This, with a little trouble, I 
ascertained to be the case." Changes were made in the distribution 
of the convalescents and the rest of the crew, and the disease was 
put a stop to completely. The crew re-embarked on the 14th of 
March in excellent health, and remained so. 1 

On taking up the limber-boards of the Dasher, says Dr. Hartle, 
"the noxious effluvia surpassed anything that I had before expe- 
rienced, and it was with difficulty that the blacks, who were accus- 
tomed to this work, could remain. The ship-carpenter, who had 
been constantly accustomed to work in the dock-yard, and on many 
such occasions, assured me that he had not before experienced so 
putrid a smell from any ship's hold. Between the timbers there 
was a collection of carpenters' shavings, &c, in great quantities. 
These had so completely choked up the limber-holes that the water 
could not pass to the well of the pump, and lay stagnant. The 
vegetable matter was, therefore, in a state of decomposition, and this, 
acted on by high atmospheric temperature, became neither more 
nor less than a marsh in the centre of the ship." " That the fever," 
continues Dr. Hartle, "was generated on board, by noxious effluvia 
received into crowded and badly- ventilated berths, is, I think, fully 
proved ; for the moment the crew and marines were removed from 
the sphere of this hidden enemy, the disease ceased." Nothing like 
the most distant appearance of contagion could be traced; for none 
but those residing on board the ship, or exposed to the effluvium 
from her hold, prior to her expurgation, suffered by the fever. 2 

That the cause of the fever resided in the hold of the Eegalia, is 
proved by the fact that the cleansing of that part proved particularly 
injurious to those exposed; and that, while the fumigation of the 
ship proved of no avail in purifying it, the fever ceased when she 
was completely cleansed, and, with her hatchways closed, her whole 
hold had been exposed to the concentrated heat of many stoves. 
In the case of the Trinidad at Barbadoes, mentioned by Dr. James 
Johnson, 3 the fever disappeared as soon as the hold was washed and 
cleansed, the dirt, filth, and stagnant water removed, and scuttles 

1 Facts and Observations in Refutation of Sir G. B. Blane's Doctrines as to the Con- 
tagion of Yellow Fever, by A. Musgrave, Appendix B., Med. Ch. Rev. and Journ. iv. 
774. 

2 Musgrave, op. cil. 774. ' Trop. Clim. 164, 1st ed. 



AUTUMNAL FEVERS. 209 

cut for better ventilation. To this, let me add that some officers, by 
the early adoption of proper hygienic measures, particularly of those 
calculated to insure cleanliness and prevent the accumulation of 
sources of impure exhalations, have succeeded in guarding their 
vessels, under the most unpromising circumstances, against the de- 
velopment of fever. While other ships were sorely visited by the 
disease, Captain Smith, of the British Navy, never had it in those 
under his command, during long service in the Mediterranean. Like 
him, many other commanders have preserved their crews by having 
"the hold of their vessels washed out daily by means of pings, till 
the water came out perfectly clear, so that an accumulation of filth 
could not take place." 1 

Here, then, we have proofs as positive as can be desired ; — limita- 
tion of the disease to the precincts, or to only one part of some 
vessel; — infection by going on board; — escape by remaining 
aloof; — great mortality among the crew or passengers, and im- 
munity among those of other vessels close by ; — the existence in the 
former of materials in a state of decomposition, or of green wood ; 
and their absence in the latter ; — the arrest of the disease by the 
adoption of a proper system of expurgation, and lastly, its preven- 
tion by proper purifying measures. We perceive that yellow, or 
malignant fever — the disease produced on those occasions, and which 
constitutes one of the forms of autumnal and epidemic pyrexiae — 
is the result of effluvia; and certainly, if one of the varieties of 
these effluvia can give rise on shipboard to one form of such com- 
plaints, and that form too the most formidable, we may justifiably 
infer that the same form of fever, when it breaks out on land, 
does so through the agency of similar effluvia ; and, as a natural con- 
sequence, that other and milder pyrexial complaints must be the 
morbid products of causes, which, though not of an identical are 
of a kindred character. 

The cause of fever wafted by winds passing over sichhj localities. 
— But we are not restricted to this inductive process for materials 
with which to establish or fortify the position here assumed respect- 
ing the malarial origin of autumnal fevers. Facts for that purpose 
may be gathered from all parts of the habitable world, and have 
been recorded from the remotest period to the present day, in the 
history of the disease. 

1 Lond. Med. Geog. ix. 890. 

14 



210 PNEUMONIA AND 

Without dwelling anew on the circumstance that fever abounds 
more or less in places where the soil is low, alluvial, flat, humid, 
and filled with organic matters in a state of decomposition ; and, on 
the other hand, that it is little, if at all known, where contrary cha- 
racters prevail, I may call attention to the fact that certain locali- 
ties — rural districts, towns or cities — which themselves do not con- 
tain any of the elements of unhealthiness, and, under ordinary cir- 
cumstances, remain free from autumnal or periodic fevers, become, 
at times, the seat of the latter, when so placed to the leeward of infected 
districts as to receive from these, through the agency of the wind, 
the pestiferous miasmata evolved from their marshy surfaces. Facts, 
indeed, might easily be accumulated to show that, in many fenny 
portions of this globe, each locality has its favourable and its un- 
favourable winds. 1 With the latter, fever abounds ; with the for- 
mer, it diminishes or disappears ; and it is found that this difference 
depends on the position of the marshy or infectious surface rela- 
tive to that locality, and also on the circumstance that, in the one 
case, those winds pass over the source of the effluvia before reach- 
ing the sickly place; while, in the other, they take a contrary 
course, and leave the latter untouched. I might dwell on the case 
recorded of Empedocles, who, having observed that the sterility of 
the soil, and the plague from which Sicily so frequently suffered, 
were caused by a southerly wind, which reached the suffering dis- 
trict through the interstices of the neighbouring mountains, di- 
rected them to be closed, and, by this means, put a stop to the ill 
effects in question. 2 But it will be more satisfactory to cite a few 
better authenticated instances which have been noticed in more 
modern times. 

On the west side of the town of Marenne, in France, are situated 
vast marshes. When the wind blows from the north, north-east, 
or east — in other words, in such a way as to preserve the town 
from the miasmata issuing from those marshes, fevers are rarely 
encountered. When reversely, the wind blows from the west, 
south-west, or south, i. e. so as to pass over those paludal surfaces 
before reaching the town, fevers make their appearance in the latter. 
On the contrary, at Saint Agnant, situate opposite to Marenne, and 
on the other side of the marshes, matters take a different turn. 

1 Melier, Mem. de l'Acad. de Med. xiii. 671 ; Jaquot, 18-36, 39, 48. 

2 Leclerc, Hist, de la MeU 93. Sprcngl, Hist, de la Med. i. 244. 



AUTUMNAL FEVERS. 211 

There, during the prevalence of the east wind, the town becomes 
sickly, while it ceases to be so when the opposite currents set in. 
The city of Eochefort owes its present unhealthiness in the autumn 
to the circumstance that the S. W. wind, which predominates at 
that season, passes, before reaching it, over the extensive and pesti- 
ferous marshes of Brouage. 1 The S. S. W. wind, by passing over 
the basin of the Anthion, opposite to Corner, in the department of 
Marne and Loire — which, in 1843, was, from a variety of circum- 
stances, in a fit condition for the elimination of miasmal exhalations 
— occasioned that year a pestiferous infection in all the neighbour- 
ing localities exposed to its influence. 2 At Bayniere, in Normandy, 
an unusual course of N". "W. winds, blowing across the marshes, 
and conspiring with a hot summer, caused very severe epidemics 
in 1809 and 1810. 3 

The Yelabrum, at Rome, the district of St. Peter, the surface ex- 
tending from the Tiber to the foot of the Janiculus, and the Trasta- 
vere generally, from the southern extremity of that mount to the 
dependencies of the Vatican, are the only unhealthy spots of that 
district, and are evidently indebted for the fever to the poison 
which, exhaling from the site of the ancient city, reaches them with 
facility through the agency of the south winds. These are unim- 
peded in their course thence by hills or other similar obstacles, 
while they find no means of escape when once they have arrived 
there. 4 Lancisi, 5 Baglivi, 6 Rigault de l'Isle, 7 and other writers may 
be referred to, in testimony of the unfavourable influence of the 
S. E. wind on the salubrity of those parts of Rome which lie to the 
leeward of the aforesaid pestiferous region, and of neighbouring 
marshes ; and of the healthiness of other localities, differently situ- 
ated. The stagnant water of Lake Aguano exhales deleterious 
effluvia, which are wafted back, in a north-eastern direction, by the 
opposite wind, on to two villages, and even to the convent of Ca- 

1 Mem. de la Soc. Roy. de Med. viii. 281. Melier, Mem. de l'Acad. de Med. xiii. 
671-2. 

2 Gaultier de Claubry, Rapport sur les Epidemies, &c. Mem. de l'Acad. xiii. 
119,120. 

3 Macculloch, 357. 

4 Carriere, Climat de l'ltalie, 372; see Am. J. July, 1851, p. 163. 

5 De Nox. Palud. Effluv. lib. 2, cap. 3. De Nativis Cceli, Rom. qualitalibus, iv. 157-8. 

6 Prac. Med. lib. i. cap. xv. Op. Om. 80. 

7 See in Johnson Trop. CI." 315; see, also, Lind on Hot Climates, 30; the same on 
Seamen, 67 ; Monfalcon, 77. 



212 PNEUMONIA AND 

maldules, situate a league off, on a high mountain, and there gives 
rise to fever, from which other localities of the vicinity are exempt. 1 
In several parts of Italy, as also in Corsica, France, and many 
other places, chains of hills, free from morasses, but placed in a line 
with them, and in the face of a wind which carries to them their 
emanations, were entirely depopulated and rendered uninhabitable. 
"Such is the malignity of a marsh lying to the south," says Lancisi, 
"that, although towns are built upon the tops of hills, exhalations 
are wafted thither, with all their mischievous properties, by the 
southern and south-western winds. Grondolpho affords a fact in 
full illustration of this, for the Lake Turnus lay formerly below it, 
full to the south. From this the air was vitiated, although the 
prospect was not injured at all. The ill effects of this were so 
serious, that Pope Paul Y. could correct them in no other way 
than by draining the lake to dryness. In commemoration of which, 
the following inscription in marble is to be seen in front of the 
government-house at Gondolpho : "In the year of our Lord, 1611, 
Pope Paul V., finding the town to be on the decline from the 
scarcity of water, and the noxious exhalations of Lake Turnus, con- 
tributed to its health and joy by bringing water hither from the 
distance of three miles, and by drying up the lake, in the seventh 
year of his pontificate." 2 

The marshes of Mantua, Ferrara, Noverra, Yerseuil, afford simi- 
lar examples of the effects of winds in transferring the cause of 
fever from one spot to another. In Yenice, the north-east wind is 
healthy, and blows the miasmata of the lagunes on the continent. 
The opposite winds, on the contrary, waft those miasmata, as well 
as those of the Lido, and of the mouths of the rivers that open into 
the former, over the city, and fever, in the exposed districts, is the 
consequence. 3 On the occurrence of an east wind there is always 
an increase of febrile diseases in London, which is attributed, in 
great measure, to the influence of marshes in distant parts. Marsh 
fever is not unfrequently noticed in the neighbourhood of Tavistock 
Square, and other places in the hollow of the northern district, 
which affords free access to the deleterious west winds. The eastern 
side of Blackheath is invariably afflicted with these winds, and dis- 

1 Valentin, Voy. Med. en Italie, 45 ; Cyclop, of Tract. Med. in. G4 ; Monfalcon, 79. 

2 Nox. Palud. Effluv. lib. i. cap. v. 20. Monfalcon, 79 ; Brown in Cyclop, of Pract. 
Med. iii. 64. Thouvenelle, Climat de l'ltalie, iv. 263. ' 

3 Carriere, 459, 463. 



AUTUMNAL FEVEES. 213 

ease is the consequence. A northern wind, blowing over the Essex 
marshes, often produces agues on the other side of the river. The 
east wind, which blows from Essex towards London, invariably 
carries it (fever) on for many miles, as all susceptible persons expe- 
rience. At the east end of London, it reaches all through Finsbury 
division and White Chapel, and is even brought at the back of the 
Strand, alons; the river. 1 It is a well-known fact, "that in the 
southern section of the United States, where the prevailing winds 
of summer and autumn are from the south and west, the dwellers 
on those sides of marshes, swamps, rivers, and mill-ponds, are often 
in the enjoyment of good health, while the people on the opposite 
sides, although farther, perhaps, from the laboratory of the poison, 
are victims to fever." 2 At Eatonton (Gra.), some thirty years ago, 
bilious fever carried off many inhabitants. The disease was satis- 
factorily traced to a mill-pond, about a mile east of the village, 
remarkable for its filth, and which, having run dry, was exposed to 
the summer's sun. From this point, the concentrated poison was 
swept, by easterly winds, to the village. The village of Mount 
Zion, Hancock County (Gra.), was, in like manner, severely afflicted 
by autumnal fever. Just previous, an easterly wind prevailed for 
several weeks, which blew directly across Beaver Dam Creek, 
nearly a mile distant, whose marshes had become dry under the 
autumnal sun. 3 During the severe epidemics of 1821 and 1822, in 
this State, it was observed " that the persons residing on the north 
and west of streams of water were peculiarly obnoxious to attacks, 
while those residing on the south side, in the immediate vicinity, 
were comparatively exempt." The explanation may be found in the 
fact that, for nearly two months of that summer, the prevailing- 
winds blew from the south, with some slight and short excep- 
tions. 4 

" Since the month of July, 1843," says M. Gaultier de Claubry, 
in one of his excellent reports on the epidemics of France, " inter- 
mittent fevers, which were originally sporadic in the commune of 
Orville-la-Mer, have assumed the epidemic character, and reached 
every part of the place, as well the habitations of the rich as those 

1 Edinb. Rev. xxxvi. 542. Second Rep. of the London Commissioners, 1848, p 40. 
Rep. on the Drainage of the Lands formiDg the Sites of Towns, 5. London, 1852. 

2 Caldwell on Malaria, 135. 

3 Pendleton, Charleston Med. J. vii. 450. 

4 Rep. of the Burks Co. Med. Soc. in Tr. of Pennsyl. State Med. Soc. ii. 93. 



214 PNEUMONIA AND 

of the poor. The N". N. E. wind, which has continually prevailed, 
by passing over the pond (situated at some distance), has wafted the 
paludal miasmata which are there formed into the principal street 
of Orville, which faces the source of the infectious atmosphere." 1 

The east wind which passes over the marshes of Echats, carries 
every autumn periodic fevers, often of a pernicious character, to 
the banks of the Saone as far as Trevoux, at the distance of two 
leagues from the river. 2 

Intermittent and bilious fevers often prevail at Macuto, and at 
Caravalleda (South America) ; and when, from time to time, the sea 
breeze is interrupted by a westerly wind, the little Bay of Coria 
sends an air, loaded with putrid emanations, towards the coast of 
La Gruayra, notwithstanding the rampart opposed by Cape Blanco. 3 
Again, the situation of the Laguna of Campoma (a great meer, which 
is divided, in dry weather, into three basins, situate to the north- 
west of Cariaco, near the extremity of the gulf of that name), ren- 
ders the north wind, which blows frequently after sunset, very 
pernicious to the inhabitants of that little town. 4 

At the Naval Asylum, near this city, where fever is of very 
common occurrence at the usual season, one wing of the building 
is much more frequently afflicted by it than the other, evidently 
owing to the fact of its being more exposed to the S. "W. wind, 
which passes over the marshy banks of the Schuylkill Eiver. 
Among several other instances of the same kind that could be men- 
tioned, I select the following, for which I am indebted to a highly 
valued friend in Charleston. The hospital, formerly at Fort John- 
son, was located on the margin of the marsh upon a high sandy 
ridge, with a small depression or basin on the western side of it. 
About three hundred to four hundred yards south-west, were 
several ponds surrounded by the wild myrtle, cedars, swamp oak, 
and short-leaf pine. When my informant took medical charge of 
the station, he learned that his predecessors were of the opinion 
that the western half of the hospital was unhealthy. Such was 
the report of the day, and observations subsequently made con- 
firmed the opinion of those gentlemen. For example, it was found 
that persons placed in the western rooms were attacked with inter - 

1 Mem. de l'Acad. de Med. xiv. 123. 

2 Groffier, Mem. sur rinsalubrite" de la partie Meridionale du Dept. de l'Ain, 19, 
Foderg, v. 152. 

3 Humboldt, Personal Nar. Hi. 399. 4 Ibid. 108. 



AUTUMKAL FEVEES. 215 

mittents, from which some with difficulty recovered, the disease 
assuming all the violence of what is commonly known in Charleston 
as country fever. The observations were made for several seasons, 
and with the same results. " The hospital was removed to Sullivan 
Island, and the location occupied by private residences, which are 
at certain seasons liable to intermittents. The season after the 
hospital was abandoned by the government, and before its removal, 
it was occupied by several families of planters from the interior. 
Those who inhabited the western half of the building were dan- 
gerously ill, while the residents of the eastern escaped." " In 
1845, a fearful epidemic among children at this settlement (diph- 
therite or membranous sore throat) made its appearance. In the 
village of Johnsonville, the mortality was terrible for so small a 
community; while, on the United States side of this line, there 
was not a single case of the disease amongst a population of forty- 
nine children, most of whom were subject to every exposure, and 
living almost entirely upon salt provisions. This line of malarial 
demarcation was well defined at Fort Johnson, and the boundary 
of health and disease could be narrowed down to a very limited 
compass." 

In an account of the medical topography and diseases of Miami 
County, Ohio, Dr. Yolney Dorsey remarks: "The same observation 
may be made here which is said to hold good throughout the West, 
that those persons inhabiting the eastern side of streams are more 
liable to miasmatic fevers than those located on the western border. 
This, it is believed, is attributable to the fact that most of the 
streams overflow their banks in the winter and spring, and are 
almost entirely dried up in the summer and fall, and as at this 
season westerly winds prevail, the miasm produced by the burning 
sun acting on the decaying vegetable matter along their course is 
driven on to the eastern banks. Many lofty and picturesque 
situations on the eastern side of the Miami Eiver are thus rendered 
uninhabitable from the yearly recurrence of autumnal, inter- 
mitting, and remitting fevers." 1 

Such facts are, indeed, familiar to our physicians — to those espe- 
cially who practise in rural districts ; for they every day find that, 
during fever seasons, one side of watercourses is generally more 
sickly than the other, and that the difference depends on the course 

1 Trans. Am. Med. As. \. 450. 



216 PNEUMONIA AND 

of the wind. Dr. Pendleton, to whose essay on the topography and 
diseases of middle Georgia I have already several times referred, 
informs us, that he has frequently, in the course of his practice, 
known fevers to prevail on one side of a creek for days together, 
while the other was entirely exempt — a circumstance, he rightly 
thinks, in no way to be accounted for but by the drift of malaria. 

In Freetown, Sierra Leone, the agency of the wind in conveying 
the cause of periodic fevers — remittents and inter mittents — is very 
satisfactorily demonstrated. Here, as in most other sections of 
tropical regions, these diseases become numerous and frequent after 
the descent of the first rain. At this period the wind generally 
blows from the northward and eastward, and consequently bears 
from the Bullom shore, or the north bank of the Mitomba — the 
countless stagnant pools and extensive marshy tracts which, 
loaded with decomposing vegetable matter, have been so graphi- 
cally described by Mr. Boyle — a large quantum of the noxious 
vapours therein generated. The direct agency of the wind in con- 
veying these vapours is established by the fact that, at the 
approach of the dry season, when again the formation of malaria 
is active, the winds but rarely blow from the swampy Bullom, and 
fevers are less frequent in their occurrence and decidedly less fatal 
in their consequences. 2 

Trincomalia (Ceylon) — and very many other places might be 
mentioned — is never sickly while the north-east monsoon prevails, 
and does not become so till the south-west wind reaches it from the 
opposite shore of the island, after having passed over a great extent 
of low, wooded, and very unwholesome country. 3 

1 Charleston Med. J. vii. 450. 

2 Boyle, Pract. Med. Hist. Ace. of the Western Coast of Africa, 124, 126 ; see also 
p. 44. 

3 Davy's account of Ceylon, 76, 4to. 

It not unfrequently happens that the cause of the disease, ■while wafted to a 
considerable height above marshy surfaces, and there producing its usual effects, 
spares, to a greater or less extent, individuals residing in the close vicinity of, and on 
a level with, the source of the infection ; or at least does not affect them more exten- 
sively or severely than the former. This has been noticed in various parts of 
France, Italy, this country, and the West Indies (Monfalcon, p. 80). Experiments 
made in France, more than half a century ago, leave no room to doubt that the result 
is due to the upward tendency of effluvia, under the influence of the wind ; and of 
their being arrested in their horizontal migration by the heights they encounter. In 
the insalubrious localities of the Bresse, white linen sheets were attached to high 
steeples on the most elevated hills of the vicinity, and an equal number suspended to 



AUTUMNAL FEVEKS. 217 

Other instances of like import, relative to the effect in question, 
as observed in Algeria, Batavia, South America, Africa, the West 
Indies, Borneo, Spain, and this country, are on record, and might 
easily be adduced. 1 But these must suffice. When taken in con- 
nection with those instances which, though generally disbelieved, 
appear, nevertheless, to rest on respectable authority, of the febrile 
cause being wafted in the common atmosphere to the distance of 
several miles— even from Holland to England, as believed by Mac- 
culloch 2 and others ; 3 of ships receiving the infection at a great dis- 
tance from land — not less than three thousand feet, according to Sir 
Gilbert Blane; 4 and of fevers being derived, as already stated, at 
Bochefoit, from the marshes of Brouage, situate four or five miles 
off; — when, I say, the preceding instances are taken in connection 
with these facts, as also with the circumstances noticed in Europe, 
from the frontiers of Asia to the other extremity of that continent, 
though particularly in Italy, that, as the western coast presents a 
larger surface of infectious marshes, so malarial fevers, other things 
being equal, prevail more extensively under the influence of south- 
west winds than of the opposite currents, they cannot but place the 
question of the morbific effect, at a distance, of winds passing over 
pestiferous localities, beyond the possibility of doubt. If we admit 

poles ten or twelve feet high, placed in the lowest fields. After the lapse of a certain 
number of days and nights, all these sheets were carefully examined, when it was 
found that the latter were merely damp ; while the former exhibited black, green, 
yellow, and livid spots. The experiment was repeated several times, and at various 
seasons of the year, and always with the same results. (lb. 81.) 

1 Jacquot, Recherches, sur les causes des fievres a, quinquina, 13, 36,89, 48; Lind, 
op. cit. 113; Osgood, 29; Horsefield, Med. Museum, i. 79; It. Jackson, Sketch, i. 
11 ; ib. Outlines, 77 ; and Treatise, 412 ; Smelt, Med. Repos. vii. 125 ; J. Johnson, 84, 
93, 153 ; Leblond, 81 ; Rush, Fev. of 1780, iv. 232 ; Evans, 24; Ferguson Recoil. 194; 
Blane, 252; Davidge, 68; Boussingault, An. de Chimie, lvii. ; Rochoux, 113; Bally, 361 ; 
Gilbert, 12; Humboldt, 765; Lefort, de la Saignee, 66; Bayley's Letters; Rep. on 
Fever of N. 0. in 1819, p. 50; Waring, 23; Chabert, pp. ix. and 26; McCabe, Ed. J. xv. ; 
Boyle, 44, 75 ; Pendleton, Topogr. of Middle Georgia, Charleston J. vii. 450 ; Smith, 
Rep. to Assembly, on Fever of 1847 in N, Y. 30, Cyclop, iii. 64 ; B. Perkins, of 
Boston, Mem. of the Roy. Med. Soc. of Paris, i. 207; Monfalcon, 79; Rand, Med. 
Repos. ii. 466-8; Fenner, Rep. ii. 442; Bryson, Stat. Rep. of H. of the Navy (Brit.), 
11 ; Second Rep. on Quar. 14, 15; Thouvenelle, Cliraat de l'ltalie, i. 223; Vincent, 
Dis. sur la F. J. 10; Mabit, Mai. de St. Dom. 5, 6. ; Diet, de Med. Pratique, vii. 74; 
Volney, Climat. des E. U. 316. 

2 Malaria : an Essay, 93. 

3 Edinb. R. xxxvi. 542 ; Boudin, Geographie Med. 70. 

4 Med. Ch. Tr. iii. ; Ibid. Dissertation, i. 236. 



218 PNEUMONIA AND 

this, we must allow, also, that the effect can only be due to the air 
thus propelled being the vehicle of some deleterious agent, which 
it receives from the infected surface, and not to the cold or heat, or 
the vicissitudes of temperature, or humidity, which such winds 
may occasion; for these, as we have seen, do not alone produce 
fevers, which often arise under circumstances rendering such an 
explanation totally inadmissible. They appear under the influence 
of the most opposite currents of air. In some cases, a north, at 
other times a south, or a west, or an east wind, produces the effect 
— the result depending solely on the exposure of the suffering local- 
ity, relative to the position of the source of malarial elimination, 
and not on any injurious quality appertaining to the wind itself, 
and existing independently of the extraneous poisonous materials 
the latter serves to convey ; for, as long ago remarked by Schner- 
rer, 1 wind of itself, whatsoever may be its thermometrical or hygro- 
metrical qualities, must be exonerated from the charge of producing 
the peculiar morbid effects in question. Sometimes the wind is a 
humid, sometimes a dry one ; and surely, heat and cold, humidity 
and dryness, cannot all be fruitful sources of a disease which is 
always fundamentally the same ; while the same winds, equally 
warm or cold, moist or dry, but lacking the extraneous poison 
under consideration, have blown for months without occasioning 
fever. 

It has frequently been found in marshy countries — and examples 
of the kind have been noticed from early antiquity in Dalmatia, 
Calabria, and Sicily — that, by changing the position of towns, 
houses, and encampments, so as to avoid the effects of winds which 
blow over marshy or malarious localities, or by preventing access 
to such winds, by closing carefully the doors and windows of houses 
exposed to them, fevers have been arrested or guarded against. 

Dr. Dundas having noticed that fever attacks were very common 
among the inmates of the British Hospital, of which he had charge, 
at Bahia (Brazil), sat about remedying the evil. In the first place, 
he made several alterations in the hospital, and had those windows 
nailed up, which admitted directly the current of wind suspected to 
cause the mischief. At the same time, effectual measures were 
taken to prevent convalescents from being exposed without cloth- 
ing. The results of these measures were immediate, and the evi- 

1 Des Epidemics et des Contagions, 92. 



AUTUMNAL FEVERS. 219 

deuce they offered was complete and apparently free from all fallacy. 
From that time intermittent fever almost completely disappeared 
from among the convalescents in the Bahia Hospital. 1 Of course 
Dr. Dundas, who ignores malaria, attributes these results to a cause 
very different from the mere shutting out of a malarial atmosphere; 
but his fact is more useful than his explanation. 

Varro, in his Treatise upon Agriculture, relates that his name- 
sake Yarro, a Eoman general, who was in great danger of suffering, 
with a large fleet and army, from a malignant fever at Conyra, 
having discovered the course of the miasmata which produced it to 
be from the south, he fastened up all the southern windows and 
doors of the houses in which his troops were quartered, and opened 
new ones to the north, by which means he preserved them from the 
fever, which prevailed in all the other houses of the town and 
neighbourhood. 

This practice, to which, attention was specially called by Thouve- 
nelle, in his clever, but eccentric work on the climate of Italy (iv. 13, 
14), had not escaped the notice of Dr. Rush, who informs us that, in 
1793, several families, who shut up their front and back doors and 
windows, escaped the disease (iii. 83). It is probable, indeed, let it 
be remarked en passant, that the benefit accruing from seclusion in 
times of severe epidemics of yellow fever and plague may be ex- 
plained in this way, and not, as is supposed by contagionists, by 
the avoidance of individuals affected with the disease, or of objects 
supposed to be contaminated with the poison. 

Let not the distance to which the cause of fever is here said to 
be occasionally wafted by the wind, deter the reader from lending 
a willing ear to this mode of transmission. Many facts are recorded 
to show that, through the same agency, other substances, diffused in 
the same manner in the atmosphere, as well as some evident to the 
sight, and of much heavier nature than the poison in question, have 
been conveyed to a considerable distance. We are told, on reliable 
authority, that on the 7th of May, 1842, soon after the outbreak of 
the great fire at Hamburg, an unusual and strong empyreumatic 
odour was experienced at Potsdam, at a distance of more than sixty 
leagues, and evidently proceeding from the direction of the burning 
city. The ashes of Vesuvius are sometimes wafted as far as Venice 
or even Greece, the distance of which from the volcano is not less 

1 Sketches of Brazil, 233. 



220 PNEUMONIA AND 

than 500 and 700 kilometres (375 and 525 miles). Instances are 
mentioned of volcanic ashes having been conveyed much farther. 
We learn that vessels at sea have, while sailing at the distance of 
700 to 1,000 kilometres (675 and 750 miles), west of the African 
coast, been covered with the red sand of that region. 1 In 1812, the 
ashes of the volcano of St. Yincent were conveyed by the wind as 
far as Barbadoes. On the same occasion those ashes fell to the 
depth of several inches on the deck of a vessel at the distance of 
181 leagues East of St. Yincent. In 1815, the ashes of the Tam- 
boro, in the Island of Sumbawa, were conveyed as far as Java, 
(108 leagues), in such large quantities as to obscure completely the 
atmosphere. 2 The odour of burnt turf, which characterizes the ex- 
halations of the Westphalian marshes, has, we are told, been sensibly 
felt as far as Brussels, Liege, and even Paris. 3 

The effects of drying, overflowing and reclaiming marshy and sicldy 
localities, and vice versa, prove the existence and agency of malaria. — 
It may not be improper to bear in mind that the banks of water- 
courses, of marshy grounds, of ponds and lakes, as well as humid 
alluvial surfaces, become, during the drying process, the seat of febrile 
diseases of the periodic kind ; while other localities in the neighbour- 
hood, but where such a desiccation is not going on — the centre of 
lakes, or river streams, the open sea, beyond the influence of land 
air — remain healthy. Let those sickly surfaces be covered with 
water, either artificially or otherwise ; cover masses of decom- 
posing materials with earth ; remove collections of putrid rubbish, 
decayed timber, or decomposed grass, or other vegetable matter, 
and fever, which before prevailed, will disappear, or greatly lessen. 
Dry up marshy surfaces, improve and reclaim the land by artificial 
means, and the same beneficial results will be obtained. On the 
other hand, let a surface of country heretofore healthy — whatever 
be its dimensions — be converted into a marsh, morass, or anything 
of analogous kind ; as is yearly seen in various parts of Africa, 
Asia, and America ; let a river bank be temporarily overflowed, 
and then partially dried; let a portion of low land daily covered 
by water at high tide, be imperfectly banked, in such a way that 
the admission of the water is only partially prevented, while its 

1 Becquerel, Sur les climats, 256. 2 Boudin, Gdogr. Med. 70. 

3 Diet. Pratique, art. Emanation, vii. 74. 



AUTUMNAL FEVERS. 221 

complete egress is impeded ; cut down a forest, and thereby expose 
a virgin soil, rich in organic matter, or a heretofore harmless, humid 
surface, to the sun's rays ; upturn the earth, make deep excavations, 
dig canals, cut down bluffs, partially remove the water from, and 
thereby lay bare the bottom of, ponds ; let the alluvion of a river 
encroach on the water and give rise to an extension of new-made 
and imperfectly dried ground, and fevers, other circumstances aid- 
ing, will certainly occur or become more rife. All this is placed 
beyond the reach of doubt. It is, of course, impossible, in the space 
to which I am necessarily limited, to illustrate these statements by 
more than a brief notice of the principal facts connected with the 
subject, which present themselves to my memory. 

The first effects of clearing land, &c. injurious. — Dr. Rush remarks, 
in reference to the epidemics of Pennsylvania, that intermittents 
and mild remittents were converted, from clearing the country, 
into bilious and malignant remittents, and destructive epidemics ; 
and that it was not until after years of cultivation that general 
salubrity followed. A like change has been found to occur in most 
parts of New England as well as in our Western and Southern 
States. 1 As the tide of emigration advances westward, remarks 
an intelligent writer, these (lake fevers), the prevailing fevers 
of Canada, retire before it. Kingston, situated at the eastern ex- 
tremity of Lake Ontario, is, in 1840, very much healthier than it 
was in 1830 ; and Danville, two hundred miles, and Amherstburg, 
four hundred and thirty miles farther west, where, now, there are 
several cases of ague in every house in the course of the year, will, 
probably, in either ten or twenty years, be as healthy as Kingston 
is now. Besides there being less fever at Kingston than at the 
other two places mentioned, its type is intermittent, while at Dan- 
ville and Amherstburg it is often remittent. 2 

Again, we find this occurring in middle Georgia, particularly in 
that portion of it lying west of the Oconee. 3 Here the country 
boasted, at the origin of the settlement, of a salubrious climate. 
Ten years after, when the forest trees had been levelled to the 

1 Everywhere, the first clearing has been attended with an increase in the number 
of cases, and in the malignancy of fever; and, in all, healthiness has followed after 
some years of settlement. 

2 Stratton, Brief Notes on the Lake Fever of Canada, Edinb, J. 55, 348. 

3 Pendleton, Charleston Med. J. vii. 451. 



222 PNEUMONIA AND 

ground, the inhabitants began to suffer much from autumnal fevers, 
and continued to do so for the next twenty years. "Since it has 
become comparatively an old country, and few new grounds are 
brought into cultivation, it is quite healthy, the fevers being con- 
fined to the more marshy districts." See, as an example, what has 
been observed in the single town of Milledgeville. Dr. Fort, in a 
communication on bilious remittent fever, published in the Southern 
Medical and Surgical Journal, 1 informs us that this fever appeared 
there as suddenly as the face of Nature had been changed by the 
hand of man, and that for eighteen years, during the summer and 
fall, it was a formidable epidemic. " Forty years have elapsed since 
the settlement of that town, and the face of the surrounding country, 
in that time, has been completely changed. The rich soil has been 
washed away from the hills, and its deeply sanded bottoms have 
become dry. The sources of malaria have been dried up, and the 
mortality, which, in Milledgeville, at one time, from bilious fever, 
might have been five per cent, per annum, has diminished until now 
the deaths from this cause do not amount, annually, to more than 
one in two thousand." 2 

The late Dr. Williamson, of North Carolina, relates the following : 
" A gentleman in Craven County, lived on his farm above forty 
years without suffering by intermittent fevers, though his family 
consisted of fifty or sixty persons. There were about 100 acres of 
clear ground in front of his house that had been cultivated many 
years ; but there was a thick wood behind the house. In the be- 
ginning of the year 1785, he caused all the timber and shrubs that 
were behind his house, within four or five hundred yards, to be cut 
down. His object was pasture and a free circulation of air. One- 
third of his family, on the next summer, was taken down by inter- 
mittent fevers. Such complaints were not more prevalent than 
usual during that summer, in other parts of the flat country. 
Those fevers were certainly caused by exposing to the sun a large 
surface of fresh land, covered with putrescent vegetables." 3 

Dr. Heustis, in his excellent work on the fevers of Alabama, 
alludes to a similar fact in the following remarks. "For the first 
three years after my arrival in this State, in 1821, 1822, and 1823, 
the country was dreadfully sickly, and the mortality great and ap- 

1 Nov. 1848, iv. No. 11. 

2 The same statement is made by Dr. Fort, in his Medical Practice, 67. 

3 Med. and Philos. Register, iii. 844. Hist, of North Carolina, ii. 198. 



AUTUMNAL FEVEKS. 223 

palling, more especially near the rivers. The whole country was 
then new, and the warmth and humidity of the season caused a great 
and rapid decomposition in the recently exposed and turned up 
vegetable matters. Many flourishing towns upon the rivers, which 
had risen up, as it were, by the hand of enchantment, received a 
sudden check, and became suddenly, almost totally, abandoned, from 
death and desertion. Strangers from every part of the United 
States, invited by the fertility of the soil, and the beauty of the 
country, and the serenity of the climate, brought together by for- 
tuitous associations, with foreign and unseasoned constitutions, were 
suddenly swept off by thousands. In many families there were not 
well persons sufficient to attend upon the sick and dying. Never 
have I known a time of such general calamity." 

Similar results will be found recorded in the medical histories of 
Pennsylvania, New York, and all our other States, as well as in 
those of England, France, Switzerland, and other sections of Europe, 
South America, and the West Indies. 1 In a word, everywhere we 
find a confirmation of the remark long made by our sagacious 
Franklin, "that all new countries are healthy for a certain period 
after their first development. That they become inhospitable to 
man, in a partial state of cultivation, and again healthful when the 
whole soil shall be necessarily cultivated to supply the wants of a 
population." 

Partial draining injurious. — Examples of the injurious effects of 
partial draining and desiccation of wet localities, by artificial or 
natural means, and conversely of the beneficial results attending 
complete draining of marshy and insalubrious surfaces, or their 
complete submersion, are numerous and conclusive. They establish, 
beyond controversy, the fact that the insalubrity of marshy localities 
increases in compound ratio to the degree of dryness they have 
attained. They show that the greatest insalubrity and mortality 
in such localities always coincide with the period of the greatest 
desiccation, short of complete dryness; that this effect occurs earlier 

1 Volney, Climat des Etats Unis, 309; Forry, Climate of the U. S. 313 ; Drake, 249, 
381, 8, 39G, 404, 710, 717 ; U. Parsons, Dissert. 206 ; J. M. Smith on Epids. 73 ; Evans] 
15-23 ; Williams, ii. 422; Macculloch, 126, 138, 172 ; Monfalcon, 180, 181 ; Cyclopedia] 
iii. 61-2-4-82; Ludlow, N. Y. Med. and Phys. J. ii. 83;'Lcblond, 23; Lefoulou, 23; 
Julia, 129; Boussingaiilt, An. de Chimie, lvii. 151; Copland, ii. 758; Fenner's Rep. 
ii. 932; Transaction of Pcnns. State Med. Soc. ii. 42-65. 



224 PNEUMONIA AND 

in hot than in cold latitudes, where the drying process is slower; 
earlier, when the season is precocious, and the reverse when it is 
tardy. In illustration of the injurious effect of imperfect drainage, 
by which a surface covered with water, and which before was com- 
paratively innocuous, is converted into a pestiferous spot, the oft- 
mentioned case of the monastery of the Chartreuse, near Bordeaux, 
in France, may be cited. " A succession of bad fevers, before un- 
known, commenced immediately upon the removal of the water 
and the partial dryness of the land, showing themselves first in that 
part of the town which lay nearest to the land reformed, and lasting 
through several years." 1 In 1793 (4th Dec), the revolutionary 
government of France, with that questionable sagacity which charac- 
terized most of its measures, ordered the drying up of every pond 
which was susceptible of the change — the reason assigned being 
the necessity of correcting the vitiated air supposed to be produced 
by the water therein contained. Nineteen months after, on the 1st 
of July, 1795, this law was repealed ; because, in many localities, the 
drying process having converted ponds into marshes, which were 
partially desiccated after the rainy season, rendered the air much 
more insalubrious than it had ever been before. The report made 
on the subject to government by Creuse Latouche, judiciously recom- 
mended the reconversion of the marshes into ponds. 2 A similar 
accession of fever from partial and imperfect drainage occurred at 
Orville la Kiviere, in France (Department of 'the lower Seine). 

Injurious effects of the overflow of land. — The extensive prevalence 
of fever during hot weather, after the overflow of river, lake, or 
pond banks, and especially at the receding of the water, is well 
known to all medical readers, and has been noticed everywhere, 
and at all times. 3 

1 Macculloch, 114. 

2 Villerme, Annales d'Hygiene, xi. 362 ; Parent du Chatelet, ib. xi. 308. 

3 Drake, 130, 280, 372, 391 ; Bancroft, 294 ; Cycl. of Pract. Med. iii. 61 ; Evans, 
25; Macculloch, 56-70-92 ; Williams, ii. 431 ; Mem. de l'Ac. de Med. xiii. 644; xiv. 
117, 119 ; Humboldt, 762 ; Schilizzi, cited by Melier, Mem. de l'Ac. de Med. xiii. 644; 
Am. Quart. Rev. iv. 294 ; Copland, ii. 758; Garrison Tr. Am. Med. Association, ii. 191 ; 
Lcblond, 188; Nepple, 135; Jacquot, 11-22; Thevenot, 232; Second Kept, of 
Lond. Commissioners, 1848, p. 40 ; U. Parsons, 205; Ludlow, N. Y. J. ii. 86-7 ; Perier, 
Hyg. des Pays. Chaud. ii.. 174 ; Fenncr's Rept. i. 857, ii. 448; Barton Rept. 34; 
Warden, Nat. Hist, of Kinderhook, Med. Repos. ix. 619; White, Med. Repos. ix. 45, x. 
36 ; Transactions of the Med. Soc. of the State of Pennsylv. ii. 71-133 ; Buel Webster's 



AUTUMNAL FEVERS. 225 

At Massouah (Egypt), fever occurs every time the sea overflows. 1 
Those of our readers who have examined the writings of Lancisi, 
may recollect the epidemic of Balnesregium, a small town of Tus- 
cany, an interesting account of which was sent to Lancisi by the 
Bishop of the place. The disease, on that occasion, was evidently due 
to the fall or caving in of a hill-side damming up a river stream, and 
thereby occasioning the inundation of the country around, and the 
exposure of the subjacent soil to the action of the sun's rays. 2 The 
epidemics of Pesaro, in 1708, and of Toronte and Trasilone, 3 cities 
of the Compagna, in 1709, also referred to by the same writer, were 
equally satisfactorily traced to a kindred cause. The inundations 
occasioned by the overflowing of the Tiber, and the disease result- 
ing therefrom, are referred to by Livy, Dionysius of Halicarnassus, 
Dio Cassius, Strabo, &c. Like effects were observed and noted in 
the twelfth and thirteenth centuries, under the pontifical reign of 
Innocent III., and, in the fourteenth, under that of Clement V., and 
are particularly described by Lancisi, who accurately pointed out 
some of the causes of the disease to which they gave rise. Lancisi 
informs us that the river overflowed its bank in 1695. The water 
spread over a large expanse of country, filling the ditches, the 
sewers, and the canals. This, too, was followed in June, July, and 
August, by extremely hot weather. Decomposition of the sub- 
merged soil ensued, and this was followed by a malignant periodic 
fever, which spread far and wide, and occasioned a great mortality. 4 
The epidemic of pestilential, or, as we presume, malignant autum- 
nal fever, which occurred along the Po at the commencement of the 
sixteenth century, and is described by Fracastorius, was occasioned 
by the overflow of that river, by which a large portion of the 
country was covered with water, and several extensive marshes 
were formed. 5 The epidemic of Ferrara in 1728, for an account of 
which we are indebted to Lanzoni, was evidently produced by the 
decomposition of organic matter arising from the large quantity of 
rain of the preceding years, followed by intense heat. 6 

collection, 54, 55 ; James Johnson, 43, 130, 360 ; Smelt, Med. Repos. ix. 125 ; Harri- 
son, ib. x. 6; Hildreth, ib. xi. 346 ; Pitt, ib. xi. 337, Piltson, ib. y. 137; Worthington, 
ib. viii. 372 ; Lipscombe, Trans. Am. Med. Assoc, vi. 322. 

1 Auber Roche, An. d' Hygiene, xxxiii. 22. 2 De Noxiis, &c. lib. ii. 210. 

3 Ib. pp. 245 and 334. 4 / 6- l49) & c> 

5 Opera Omnia Philosophica et Medica, 1555, 4to. 100. 

6 Opera Omnia, iii. 4to. Lausanne. 

15 



226 PNEUMONIA AND 

The city of Strasburg, in France, is not often visited by mala- 
rial fevers. In 1824, the banks of the Ehine were overflowed, and 
remained for some time under water. Soon after the water had 
receded, fever began to prevail, and continued to do so during three 
consecutive years; nor did it cease before the soil had become 
perfectly dry. The occurrences which followed the great crevasses 
of 1816 and 1849, in New Orleans, and the inundation, from the 
Pontchartrain Lake, of a large portion of that city, in 1830, are 
fresh in our memories ; as also those recorded in Italy, Germany, 
Egypt, India, Senegal, Algeria, and very many parts of our own 
country. The irrigations at Dran, Karguantal, Sibi-bel-Abbas, and 
other districts of Algeria, 1 where the practice is extensively applied 
to agricultural purposes, and is carried to such an extent as to occa- 
sion a sort of daily inundation ; those of some of the departments 
of France, as well as those resorted to in the rice plantations of this 
country, have been found to give rise to the same morbific effects, 
wherever and whenever the thermometrical condition of the atmo- 
sphere is such as to aid in the extrication of malarial effluvia. 

Mr. Lee, one of the inspectors employed by the London General 
Board of Health, in reporting on the irrigation by water-meadows 
in Wiltshire, thus states his information in relation to them. It 
not only shows, as an agricultural fact, the enormous quantity of 
water requisite to produce a high state of fertility on the open gutter 
and bed system of irrigation, but also that, for about half the whole 
year, these meadows are under water. The first " turn" is during 
winter, seven days on and seven days off. The second " turn" in 
spring, four days on and four days off. The third in summer, three 
days on and three days off; then three days on and six days off. In 
every " turn," except the last, the periods of irrigation are equal to 
those during which the water is shut off; but, during the frost, the 
water is kept on, if possible, altogether. These "turns" include night 
and day. The whole of these meadows, therefore, during about half 
the year, form one large evaporating surface, as much as would be 
the case if the whole were constituted an immense lake. Even 
when the water is off, the ground is so saturated that the evapora- 
tion must still be going on. No fen or morass in any low-lying, 
ill-drained district of the country would, I apprehend, impart, area 
for area, an equal amount of moisture to the atmosphere. The 

1 Jacquot, 23. Fifevres a Quinquina. 



AUTUMNAL FEVERS. 227 

consequence is such as might be expected — ague is extensively 
prevalent in this valley, and is in some spots so general that scarcely 
any of the inhabitants, rich or poor, young or old, escape it. 

The difference between the people exposed to the influence of such 
a surface and others living in neighbouring parishes of equal popu- 
lation, but not subject to malaria, may be seen, as Mr. Lee remarks, 
in the dejected and haggard appearance of the former, and in the 
greater amount dispensed among them for poor-rates. In the 
course of his investigation into the sanitary condition of the parish 
of Longbridge Deverill, near the town of Warminster, Mr. Lee 
found that in one portion of that parish, the large village of Crocker- 
ton, scarcely any of the inhabitants had escaped ague; and, on 
comparing the poor-rates for seven years back with those of the 
parishes of Corsley and Horningsham, of about equal size, and in 
the same union, it is seen that the charges for sickness in Long- 
bridge Deverill are nearly double. 1 

The conclusions as to the insalubrity of common irrigation, and 
its unfitness for the proximity of towns, are fully corroborated by 
the fact that, in the Lombardo-Yenitian provinces, where there is 
some of the oldest, most extensive, and skilfully conducted irriga- 
tion in Europe, the government has long found it necessary to in- 
terfere for the protection of the health of towns. By law, as stated 
in some information on the subject received by the English General 
Board of Health from the authorities of Milan, "permanent" irriga- 
tions are prohibited within five miles' distance of towns. These 
permanent irrigations are there mostly applied to the cultivation of 
rice. Cases are reported, from the irrigated districts, of the appear- 
ance and disappearance of fevers coincident with the operations of 
flooding and drying particular tracts of land. It appears, indeed, 
from extensive experience, that, wheresoever water is laid on the 
land in greater quantities than it can immediately or very soon 
absorb, or wheresoever there is alternate wetting (in such excess) 
and drying, malaria is apt to arise. 2 

In the Department of Marne and Loire, in France, the basin of 
the Anthion is 32 kilometres in length, and 6 in its greatest breadth, 
opposite to Corne, and contains 1,560 hectares, or 3,000 acres of 
submersible land between the bridge of Bourgignon and that of 

1 Minutes of Information, &c. on Sewer-water and Town-manure, &c. London, 
1852, pp. 7, 8. 

2 Ibid. 9. 



228 PNEUMONIA AND 

Forge, and 1,016 hectares, or 2,032 acres, equally submersible land, 
in another direction. It constitutes an immense focus of decompo- 
sition, from which are evolved effluvia, and often paludal miasmata. 
In the more depressed portions of this surface, the inundation is 
as much as ten feet deep. It is difficult, however, to obtain a com- 
plete desiccation of it. In 1843, the whole of this basin was 
flooded, and all the ditches completely filled. The Anthion, that 
year, remained higher than ordinarily. The water continued to 
cover the greater portion of the soil, and it became impossible to mow 
the grass in a dry state. This circumstance of an immense inunda- 
tion ought, it would seem, to have proved advantageous ; for the 
whole basin was, by the overflow, converted into an immense lake, 
by which an obstacle was put to the formation of a marsh. But no 
sooner had the water somewhat subsided, and, by so doing, allowed 
the exposure during the hot weather of July and August, of the 
banks of the ditches, and of a few hillocks, than the effluvia, then 
extricated from the mass of decomposing vegetable and animal sub- 
stances therein contained, were wafted by the S. S. W. wind to the 
town, and infected the inhabitants, among whom it occasioned the 
development of an extensive epidemic of intermittent fever. 1 

The following statement is taken from a clever communication 
contained in an English periodical: — 

" The summer in this country (Russia), is farther remarkable, 
inasmuch as, from the end of May to the beginning of September, 
no rain falls, and thunderstorms are extremely rare. The pheno- 
menon isrdoubtless owing to the flatness of the country. For five 
hundred miles and more, around Perm and Kassan, there is not a 
hill of any consequence, and the whole tract from Kiew to Ural, for 
a breadth of five hundred miles, may be called a plain, only here 
and there interrupted by ranges of gentle hills. The extraordinary 
fertility, especially of the government of Kassan, is occasioned by 
the inundation of the Wolga, which overflows annually at particu- 

1 Gaultier de Claubry, Mem. de l'Acad. de M6d. xiv. 119, 120; see also 117, for 
another case of the same import. 

The Canton of Amizy-le-Chateau is situate in a valley, on the south side of the 
city of Laon. In the centre runs the small, sinuous, and shallow river of Elete, 
which is supplied with water from a number of creeks. In the neighbourhood, there 
are a number of ponds, the whole subject to overflows, which, combined with the 
peculiar nature of the soil, have given rise to extensive marshes, well known under 
the name of the southern marshes of the Laonnais. The canton is very subject to 
fevers (Bulletin, i. 154). 



AUTUMNAL FEVERS. 229 

lar seasons, as regularly as the Nile in Egypt, and converts the 
whole country, to the distance of ten miles or more from its bed, 
for five or six weeks, into an immense sea. These inundations of 
the Wolga, and the other large rivers, the Witjalka, the Kama, the 
Kinel, the Irgis, &c. which discharge themselves into the Wolga, 
render the countries through which they flow at once lively and 
fertile. At such seasons you may sail, either for pleasure or upon 
business, in large two -masted vessels, carrying from six to ten guns, 
over pastures and cornfields, to the neighbouring towns, which, 
on this account, are all situated upon heights; and, when the waters 
have withdrawn into their accustomed channels, the ground for- 
saken by them is covered often a yard deep with a fertilizing mud, 
in which, during the hot season, all vegetables grow rapidly and 
vigorously as in a hothouse. At the same time, pools are left 
behind in the low grounds, where the water stagnates for several 
months, becomes putrid, and generates putrid fevers in the months 
of July and August in these otherwise healthy countries. The 
government of Ufa, particularly, is visited about this time by an 
intermittent fever, which attacks the patient every seventh day 
only, but is so violent that it generally proves fatal." 1 "Near the 
walls of a large city," says a celebrated writer, "stood a very exten- 
sive and deep pond of water, which, for forty years, had served as 
a receptacle for all the filth from the houses and streets. As long 
as these putrid matters remained covered with water, they were 
productive of no mischief; but, when they had so far accumulated 
as to rise above the surface of the water, a most malignant fever 
spread through the tract of country adjoining the city." 2 

Dr. Cadwallader Golden, of New York, who wrote a full century 
ago, makes the following remarks : — 

"It is well known that the Paltz Eiver or Wallkill, in Ulster 
County, in this province, has been long taken notice of, as very 
prejudicial to the health of those who live on the banks of it. The 
waters of this river are of a dark colour, and come from a large 
space of ground overflowed with stagnating water. The inhabitants 
along this river, are yearly afflicted with intermittent fevers during 
the summer season, and a constant fog or vapour is observed almost 
all the summer (except in the time while the N. TV. or northerly 

1 Notices of Russia, United Service Journal, January, 1833, p. 49. 

2 Senac, De Nat. Febr. Recond. lib. i. cap. vii. fol. 34, 35. Caldwell's Trans. 20. 



230 PNEUMONIA AND 

winds blow) to arise over that river, and to remain there at a certain 
height and distance every morning, till the heat of the sun disperses 
it, and frequently, likewise, in the evening." 1 

About the same time a distinguished physician, of this city, stated 
the following fact : "A farm, within a few miles of this city, was re- 
markably healthy for fifty years, whilst the tide overflowed the low 
lands, near the dwelling-house ; Dut after they were banked in by 
ditches, so ill-contrived that they did not often discharge the water 
that fell into them for a considerable time, it became putrid, and 
thereby rendered the place as remarkably sickly as it had been 
before healthy. I was told by a gentleman of veracity "that he saw 
the corpses of nine tenants, that had been carried from it in a few 
years." 2 

Between Winchester and Charlottesville, in the valley of Yirginia, 
is situate a remarkably large and deep spring, from which extends 
a low, marshy piece of ground about a mile long, and perhaps one 
hundred yards wide. All around this marsh the people have been 
annually subject to fevers in an unusual degree. In the very wet 
year of 1823, however, the marsh being inundated, they almost 
entirely escaped. 3 The readers of Pringle will remember the occur- 
rences in Brabant during the campaign of 1748. "The country 
bordering upon the lower part of the Maas is not only unhealthful 
on this account (the humidity of the soil under the surface), but, 
by reason of floods from the small rivers, lies all the winter under 
water, and continues damp throughout the summer. The moisture 
and corruption of the air were much increased by the inundations 
(which had been made about the fortified towns since the com- 
mencement of the war), and sensibly became more noxious upon 
letting off part of the water, in the beginning of the summer." 4 

Dr. Kobert Hamilton, of Lynn Eegis, in a pamphlet quoted by 
Bancroft, and referred to particularly in the Lond. Med. Gaz., de- 
scribes a remittent fever produced in that place, in 1779, lyy a freshet 
which occasioned an inundation from the sea. " The inundations 
from the sea are generally followed by severer consequences in re- 
spect to health, than those from the fresh water. If they extend far, 
they cover much low ground under cultivation, and fill many ditches, 

1 N. Y. Med. and Philos. Register, i. 323. 

2 Bond, Tntrod. Lect. N. A. Med. and Surg. J. iv. 270. 

3 Cooke on Eped. Fevers, Med. Recorder, vii. 457, 8. 

4 Diseases of the Arm y, 61. 



AUTUMNAL FEVEES. 231 

■which, in many situations, cannot be drained by any other means 
than evaporation by the heat of the sun." " The remittent fevers 
which follow are of the worst kind; — the effect being due to the 
dead fish that remain, and the effluvia from the destruction of rep- 
tiles, insects, &c, and vegetables which are destroyed by the sea 
water." The gale of 1779 was attended by such an inundation, the 
effect of which, developed by the" heat of five successive summers 
and autumns, were seen in the fevers of those years, which were 
more violent, universally epidemic, and more fatal than Dr. Hamil- 
ton had seen them in the past forty years. These fevers have 
ceased to show themselves. The country around, which was one 
of the most unhealthy, has become one of the most salubrious, by 
the complete draining of the Bedford level. 1 

"Near Guerande and Pont Chateau, several localities on the coast 
of Britanny partake more or less of the insalubrity of marshy sur- 
faces. Among these may particularly be cited the towns of Dinan, 
Dol, Lamballe, and their environs, in consequence of the high tides 
occurring on this part of the coast, and resulting from the obstacles 
to the free flow of the sea from the western coast of the Cotentin. 
The waters thrown back by that coast are carried to, and accumu- 
late in, the bays of St. Michel, St. Malo, and St. Brieux, where they 
rise to the height of forty feet, and overflow the country far beyond 
Dinan, spreading miasmata to the north and south." In the same 
way, in the Bay of Isigny, the sea rises to a great height, and occa- 
sions the overflow of the rivers, especially in the vicinity of Carentan, 
which is surrounded by stagnant water during several months of 
the year. "Hence the city and its environs are seldom free from 
fevers and other kindred diseases." 2 " In the province of Poitou, 
the insalubrity of most of the towns and villages arises in like 
manner from the exhalations generated in the morasses and ponds 
by which they are surrounded, owing to the overflow of the rivers. 
Thus the Sevre, in which the sea penetrates, overflows its stagnant 
waters during several months of the year, to the depth of two, four, 
and even six feet, and inundates the whole country around Lucon, 
Maillezais, and Marans, as far as two leagues below Mort, thereby 
forming a marsh of 65,085 arpents in extent. All this country is 
subject to intermittent fevers and other diseases." 3 

1 Lond. Med. Gaz. xxviii. 790. 

2 Boncerf, Mem. de la Soc. Roy. de Med viii. 282, 3. 

3 lb. 282. 



232 PNEUMONIA AND 

Mr. Ives, in the narrative of his travels from India to Europe by 
land, relates the following interesting and apposite fact : — 

" After sailing up the Eiver Tigris, from Bassora, we arrived at 
Bagdad. In this city, supposed to contain 500,000 souls, a purple 
fever then raged ; but though it was computed that an eighth part 
of the inhabitants were ill, yet the distemper was far from being 
mortal. Here we were informed that the Arabs had broken down 
the banks of the river near Bassora, with a design to cover with 
water the deserts in its neighbourhood. This, it seems, is the usual 
method of revenge taken by the Arabs, for any injury done them 
by the Turks in Bassora ; and it was represented to us as an act of 
the most shocking barbarity, since a general consuming sickness 
would undoubtedly be the consequence. This was the case fifteen 
years before, when the Arabs, by demolishing the banks of this 
river, laid the environs of Bassora under water. The stagnating 
and putrid water in the adjacent country, and the great quantity 
of dead and corrupted fish at that time lying upon the shore, pol- 
luted the whole atmosphere, and produced a putrid and mortal 
fever. Of this fever, between 12,000 and 14,000 of the inhabitants 
died ; at the same time, not above two or three of the Europeans 
who were settled there escaped with life." 1 

In the summer of 1780, a violent remittent prevailed in that 
city, so general in its attacks, and so fatal in its effects, that it 
destroyed 25,000 persons, and was called a plague. The disease 
on this as on other occasions was manifestly owing to the cause 
mentioned, which, after moistening to saturation a great extent of 
the banks of the river, was speedily followed by intense solar desic- 
cation, during which the fever appeared. 2 Indeed, the same effects 
are frequently produced at Bassora, and to a highly destructive 
degree, after the ordinary overflowing of the Euphrates. Of the 
consequences arising from simple inundation, "Egypt affords, as we 
have seen, a similar example ; inasmuch as its season of fever com- 
mences with the subsidence of the Nile. Every one must know, 
that equally disastrous results have often followed the overflowing 
of the Adige, the Po, the Scheld, the Saave, the Theisse, the Don, 
the Tigris, and other streams. 

Hungary is as sickly a country as any other in Europe, and is 

1 Lind, on Hot Climates, 118, 119. 

2 Oaigie's Practice, i. 172; Trans, of a Society for the Improvement of Med.-Chir. 
Knowledge, ii. 55. 



AUTUMNAL FEVEES. 233 

scarcely exceeded in that respect by any on this side of the Atlantic, 
or in Africa. Its fevers, which in the short space of a few years 
destroyed forty thousand Austrian soldiers, has, under the name of 
morbus Hungaricus, become familiar to all medical readers. Here, 
the same causes which render other localities injurious to health, 
and prolific of febrile complaints, subsist in an eminent degree. 
" Hungary abounds in rivers, some of great magnitude — the Danube 
and the Drave, which, by often overflowing, leaves that low, flat 
country overspread with lakes and ponds of stagnating water, and 
with large unwholesome marshes." 1 

The fevers of Senegal, described by Thevenot, and before him 
by Schotte, are due to the annual inundation of the river of that 
name. Containing but little water during eight months of the year, 
it fills up rapidly during the wet season, and, soon rising to a height 
of more than 38 or 40 feet beyond its proper level, spreads — as do 
also its many tributary streams and neighbouring lakes, which 
before were dried up — its waters over the whole country, which 
now presents, like Egypt, during the inundation of the Nile, the 
appearance of a vast expanse of water dotted over with villages. 
On the subsidence of this, fever breaks out. 2 

u The garrison of Fort Augusta, which stands very near some 
marshes, to which it is to leeward when the land wind blows, was 
yet remarkably healthy; but it became at one time extremely 
sickly upon the breaking in of the sea in consequence of a high 
tide, whereby the water, which was retained in the hollows of the 
fort, produced a putrid moisture in tlie soil, exhaling a vapour of- 
fensive to the smell, and with all the noxious effects upon health 
commonly arising from the effluvia of marshes." 3 

The yellow fever epidemic of La Guayra, in 1797 — the first 
known to have occurred in that place — has been referred, with 
much plausibility, to the overflowing of the river of that name. 
" This torrent, which in general is not ten inches deep, was swelled, 
after sixty hours of rain in the mountains, in so extraordinary a 
manner that it bore down trunks of trees and masses of rocks of 
a considerable size. During this augmentation, the waters were 
from thirty to forty feet in breadth, and from eight to ten feet in 
depth. Many houses were carried away by the torrent, and the in- 

1 Lind on Seamen, 59 ; Pringl. ] 89. 

2 Thevenot, Maladies des Europe'ens, &e. 20, 21. 

3 Blane, Diseases of Seamen, 2d edit. 229, note. 



234 PNEUMONIA ANJ) 

undations became more dangerous for the stores, in. consequence of 
the gate of the town, which could alone have given an issue to the 
waters, being accidentally shut. It was necessary to make a breach 
in the wall in the sea-side ; more than thirty persons perished." 1 

Bad effects of copious rains followed by great and desiccating heat. — 
A wet season, or heavy temporary rains, by converting dry and 
heretofore healthy tracts of country into swamps or marshes, or by 
merely thoroughly softening a soil previously hardened by a dry 
spell of weather, and mostly destitute of vegetation, has, when fol- 
lowed by heat, given rise to a considerable extent of disease. 2 Hence, 
in localities which are naturally dry, or which have been rendered 
so by long-continued and intense heat, the rainy season is that of 
the greatest insalubrity, and continues so until the soil becomes com- 
pletely submerged. Indeed, the fresh rains often become the signal 
for the breaking out of the disease. Among the many facts that 
might be cited in corroboration of the former statement, I shall select 
the following: In Corsica, fevers break out in August and Septem- 
ber, not only along the marshes, but in the villages situate between 
the mountains, on the occurrence of heavy showers. 3 Speaking of 
1839, Mr. Gouraud says : "I was beginning to think that the extent 
of the annual endemic had been greatly exaggerated. On the 20th of 
August, during a very hot spell of weather, we had a shower. The 
latter produced, instantaneously, a very offensive odour, and decided 
the development of pernicious intermittents." 4 Similar effects of 
the first rains are noticed in the Morea. On their landing there, in 
1828, the French troops were exposed to intense heat by day and 
cold by night. These vicissitudes, succeeding to a long period of 
dryness, invited the approach of the annual epidemic. Rain fell in 
heavy showers on the 18th and 19th of September, and the disease 
broke out on the 20th. 5 A gentleman, living on the ridge land 
between the Opequon and the Shenandoah Rivers, in Yirginia, in- 
formed Dr. Cooke, from whose essay on Epidemic Fevers I quote : 
" That he had, for nineteen years before 1823, scarcely known what 
sickness in his family was. A neighbour had been in the habit, 
for many years, of watering his meadow by small rills, from his 
mill-race. Before this wet year, the quantity he could spare was 

1 Humboldt, Pers. Nar. iii. 292. 

2 Villerme, An. d'Hyg. xi. 350; Leblond, 100, 184. 

3 Gouraud, Etudes sur les F. Interin. Pernicieuses dans les contrees nieridionales, 37. 
* lb. 40. 5 /j, 218. 



AUTUMNAL FEVEKS. 235 

very small, and not enough to make the ground wet, the moisture 
being absorbed immediately. This year, however, it was quite 
marshy, and the road through it very bad. The consequence was, 
that a great number of persons died in the houses just around the 
meadows." 1 

In 1830, the city of Macacu, in the Province of Kio Janeiro (Bra- 
zil), on the banks of the river of that name, suffered extensively from 
periodic fever. The district around the city is rich in virgin forests 
and in coffee, sugar, rice, and other plantations. Thence the disease 
extended far and wide, occupying a surface of argillaceous soil, cut 
up by numerous streams, torrents, and lakes bordered with man- 
groves, and subject to inundation at high tides. The epidemic was 
evidently due to a great drought, which occurred in 1829-30, and 
succeeded to heavy rains, which flooded the country. 2 

It may be mentioned, in illustration of this, that sickly seasons are 
generally those in which a wet spring is followed by a hot summer. 
T\ T e have seen that in Africa, in the East Indies, in the Antilles, and 
in South America, fevers make their appearance at the commence- 
ment and a short time after the close of the rainy season ; when, 
consequently, the soil is not yet deluged with water, or when it has 
ceased to be so, and offers, by its exposure in a moist state to the 
evaporating power of the sun, and by the greater luxuriance of 
vegetation which ensues, ample food for the generation of the febrile 
poison. This is equally true, both as regards common autumnal, 
and malignant yellow fever. While they all often commence and 
rage soon after the appearance of rain, and are sometimes put a 
stop to by excessive and long-continued drought, they seldom break 
out in an epidemic form during a very dry spell of weather, unless 
the latter has been preceded by a wet spring, or a quick succession 
of heavy showers, by which the earth is thoroughly saturated. 
Facts illustrative of these effects have been observed everywhere, 
both abroad and in this country. 3 It is on those observed by him- 

1 Med. Recorder, vii. 457. 

2 Sigaud, du Climat et des Mai. du Brazil, 170-2. 

3 Town, 7-9; Warren, 8; Chalmers, i. 19-22; Macartney, quoted by Dickson, Ed- 
inb. Journ. xiii. 47; Humboldt, 765; Desportes, i. 17, 121 ; Lind, 50; Bailly, Fievres 
Interm. 130; Clark, Med. Notes on Climate of Italy, 80; Tommasini, ii. 488, 9; Da- 
vidson, quoted by Rush, iv. 155; Halphen (of N. O.), 42, 43; Pallas, 209, 210 
Report of Sickness of British Army, 4-23 ; Savaresi, 256, 257, 292 ; Pugnet, 344, 345 
Mosely, 10, 11; Chisholm, i. 146, 147; Belcher, Ed.' Journ. xxiii. 248; Dariste, 33 
Davidson, Med. Repos. viii. 248, 249; Catel, 7; Dazille, 10; Ed. Journ. lxiii. 448 
Dupre, Am. Journ. N. S. iii. 265; E. H. Smith, Webster's Collection, 75; Bayley, 



236 PNEUMONIA AND 

self and others in the West Indies, though especially in Holland, Spain, 
and Portugal, that Dr. Ferguson built his theory of the exclusive 
agency of the drying process, that grew with him into a hobby, which 
he rode manfully and with much ability to the last day of his life, 
and which a few of our countrymen would seem disposed to mount, 
strangely unmindful of many other facts which strongly militate 
against its exclusive adoption, and show, as we have seen, that, 
under certain circumstances, malarial fevers not unfrequently ap- 
pear under the influence of the wetting process. 

The establishment of mill-dams, and the subsequent partial de- 
siccation of the soil, have the same effect. Dr. 0. "W*. Holmes, who, 
besides writing amusing poetry, composes excellent medical essays, 
adduces, in a work of marked ability, a large body of facts, showing 
the injurious effects of these dams, and of ponds. 1 Dr. Eush, 
in enumerating the causes of the increase of remittent bilious 
fever in and about the year 1785, mentions, prominently, the esta- 
blishment of dams ; 2 and Yolney has expressed himself strongly in 
their condemnation. 3 Harrisburg, in this State, situate between 
the Eiver Susquehanna and a small creek, and extending nearly or 
quite from one to the other, furnishes an acceptable illustration of 
the above fact. In the year 1773, a dam was built across the creek, 
in the rear of the town, and thereby produced a very extensive 
and shallow pond. In the fall of the year succeeding, a mortal 
fever prevailed in the town, which was satisfactorily traced to the 
influence of that pond. The people insisted on having the dam 
removed. The pond was completely drained, and the town was as 
healthy afterwards as it had been before that time. 4 Mifflin County, 
in this State, is generally free from sources of miasm al exhalations. 
In 1823, intermittent fever prevailed extensively; but it was con- 
fined exclusively to the immediate vicinity of mill-dams. A few 
cases, in the more healthy districts, could be traced, in every in- 
stance, to the same source, or to a visit to the river. 5 

53, 123; Ralph, Edinb. Med.-Chir. Trans. 55-60; Doughty, 187, 188; Lewis, N. 0. 
Journ. for July, 1848, p. 38 ; Pinkard, ii. 60 ; Leblond, vii. 100, 106; Villerme, An. 
d'Hyg. xi. 350. 

1 Boylston Prize Dissertations (Interm. Fever) 47. 

2 Rush, An Inquiry into the Causes of the Increase of Remittent and Intermittent 
Fevers in Pennsylvania. Philosoph. Trans, ii. 206. 

3 Volney, Climat des E. U. ii. 309, &c. 

4 Cooke on Epid. Fev. Med. Recorder, vii. 452. 

5 Trans, of State Med. Society, ii. 44 ; see also p. 47. 



AUTUMNAL FEVEES. 237 

Dr. Drake, in his imperishable volume, relates the following 
strong fact : The village of Washington, in the State of Ohio, stands 
on the north-east side of Paint Creek. About the year 1826, a mill- 
dam was erected a short distance above the town, which caused the 
inundation, to the depth of a few feet, of about sixty acres of bottom 
land. As the stream generally fell too low, by the first of June, to 
admit of grinding at the mill, it was the custom of the proprietors 
to open the floodgates, and let the water escape, 1 after which the 
copious showers of that month commonly washed away the recent 
deposits, and thus the health of the village did not appear to suffer. 
In the year 1838, the owners did not let off the water until July, 
and no rains followed to wash away the silt. In a short time an 
offensive smell was wafted from this foul and drying surface into 
the village, which was to its leeward, and, in the month of August, 
the inhabitants began to sicken with remittent and intermittent 
fevers. Those who lived on streets nearest to the pond, suffered 
most. The people who resided in the vicinity, to the west, or 
windward, did not suffer. No epidemic, so severe, had ever visited 
the village before. In the succeeding years, up to the time of 
Dr. D.'s visit, in 1840, the waters had been drained off the first of 

1 Speaking of the upper Cuyahoga Basin, Dr. Drake remarks that it is annually 
more or less infested with autumnal fever, although elevated eleven hundred feet 
above the sea, and in the mean latitude of 41° 30 r N. ; but the banks of the ponds 
and marshes are much infested. "Thus, I was told by Mr. Coles, of Chardon, that 
when a dam was built across the Cuyahoga, at Burton, the people were, in the two 
next years, generally attacked by autumnal fever; and Dr. Hamilton, of the same 
town, informed me that, in the neighbourhood of Burton, a dam was demolished in 
summer or autumn, and nearly all the labourers engaged in the work sickened with 
fever. From Dr. Bennett, of Sharlesville, I received the following facts : The Cuya- 
hoga flows near the western side of that village, from east to south-west. To obtain 
water for the Mahoning Canal, a dam was thrown across the river, which gave rise to 
many cases of fever. Two years afterwards a higher dam was erected, lower down 
the river, which raised the water to the level of the first, involved the ruin of an old 
mill, produced stagnant water in the mouths of many small streams, inundated some 
forest land, and so intercepted the volume of water flowing in the river, that when 
it became reduced, in autumn, the whole was transmitted through the canal-feeder, 
leaving but a series of pools in the partially dried up river bed below. During the 
first autumn after this signal change in the condition of the river, no injury to health, 
was experienced ; but in the next, nearly all the inhabitants, on both sides of the 
river, above and below the new dam, were attacked with autumnal fever. The num- 
ber of cases was estimated at one hundred and fifty. They who lived near the river 
had intermittents ; those who resided farther off, and on higher ground, suffered more 
from remittents." Pp. 372, 3. 



238 PNEUMONIA AND 

June, and much of the drift-wood and filth cleared away ; in con- 
sequence of which, apparently, the epidemic had not occurred. 

The same writer relates the following example : "On Cedar 
Creek, a tributary of the Cumberland Eiver, a mill-clam had been 
erected, about sixteen feet high. After twenty-two years, the basin 
having become filled with silt and dross, the dam was torn down, 
and the perpendicular face of the deposit exposed to the action of 
the sun and air, in the month of August. The consequence of this 
was, that nearly all the men who performed this labour were seized 
with severe antumnal fever, and one died. 1 " 

The following fact is related by another American writer, Dr. Lud- 
low, of New York. A mill-pond in the vicinity of Lyons, Ontario 
County, which overflowed ten or fifteen acres of land, was drained, 
in the summer of 1822, for the first time, the mill having been built 
about five years. In consequence, about thirty people in the im- 
mediate vicinity were taken suddenly ill, seven or eight of whom 
died. Some of the intermittents were very malignant. 2 

Macculloch refers to equally strong facts as observed in the iron 
district of Glamorganshire, at Hirwren, and other parts of South- 
end, near Lewisham, in Hertfordshire, and elsewhere in England. 3 

Injurious effects of upturning the earth in hot weather. — It has 
already been stated that the digging of canals, the opening of 
ditches, the cutting down of bluffs, the levelling of lots, the filling 
up or digging down of streets, the opening of roads, the establish- 
ment of brickyards, &c. have proved highly injurious, not only in 
this country, but in parallel or hotter latitudes, as also during the 
hot seasons of cold regions. The results of operations of the kind 
in the East and West Indies are on record, and, like those in Alge- 
ria, an account of which has recently appeared, are of a nature not 
to be easily forgotten. Near Tlemcen, in Algeria, nearly all the 
soldiers employed in digging a well were attacked with fever, while 
all the others in the vicinity escaped. 4 The opening of roads, and 
the upturning of the earth for various purposes, are recognized, by 
the entire body of physicians attached to the French army in that 

1 Topogr. &c. of the Miss. Valley, 717. 

2 A Stat, and Med. Account of the Genesee Country, N. Y. New York Med. and 
Phys. J. ii. 89. 

3 Op. cit. 101-103. 4 Jacquot, Fievres a Quinquina, 29. 



AUTUMNAL FEVERS. 239 

country, as having given rise to the extensive development of fever. 1 
The writings of Dr. Drake, 2 so often cited, those of Evans, 3 Blane, 4 
Cassan, 5 Macculloch, 6 Usher Parsons, 7 Caldwell, 8 Bayley, 9 Tho- 
mas, 10 Anderbach, 11 Davy, 12 Gaultier de Claubry, 13 and many others, 
abound in similar cases. Dr. Merrill, in an essay on the yellow 
fever of Natchez, has taken great pains to show, and with every 
appearance of success, that the epidemic of 1823 arose from the 
levelling of the streets, and the consequent exposure of the fresh 
soil to the action of the hot sun. 14 

The same able physician, in an excellent and interesting anniver- 
sary address read before the Medical Society of Memphis, Tennessee, 
on " the health and mortality" of that growing city, has traced the 
great sickness and loss of life that recently occurred there, princi- 
pally to the work of grading and digging, which has been exten- 
sively carried on for several years past, and which produce an 
obstruction to free drainage. " In this," says Dr. Merrill, " I am 
sustained by the opinion of Dr. Grant, in his able address before 
this Society at our last anniversary, by many of the members of 
the Society, by the Board of Health, and by many persons of learn- 
ing and experience who are not members of the medical profession." 15 

The injurious effects of these works is farther illustrated by 
occurrences in Charleston, in 1842 and 1852: "In 1842, white 
labourers, strongly predisposed to yellow fever, were employed in 
opening drains and other works, and transferring the earth to dif- 
ferent portions of the city; and where the drains were opened and 
the earth was deposited, there yellow fever occurred, and the unfor- 
tunate beings who performed that work were the greatest victims. 
In 1852, the same thing occurred." 16 Dr. Simons remarks, in a note, 
that, in reference to the last-mentioned year, at the new custom- 

1 Ibid. 13-29. 2 Op. cit. 182, 229, 235-239, 372. 

3 Op. cit. 75, 266. 4 Dissertations, i. 332. 

5 M6m. de la Soc. Me\l. d'Emulation, v. 142. 

6 Op. cit. 83, &c. 7 Essay on Malaria, in vol. of Essays, 206. 
8 Essay on Miasm, Boston J. ii. 504. 9 Yellow Fev. of New York in 1795. 

10 Essai sur la Fievre J., 1st ed. 71. " N. Y. J. ii. 75, N. S. 

12 Second Rept. on Quarantine (Lond.), 57. 

13 M6m. de l'Acad. de MeU xiv. 120. 14 Philad. Med. and Phys. J. ix. 340. 

15 Memphis Med. Recorder, i. 85-94; see, also, Grant, "The Meteorology, Sani- 
tary Condition, Prevailing Diseases, and Mortuary Statistics of Memphis," Ameri- 
can J. July 1853, 74, 115 ; see, also, a paper by the same, in N. 0. J. for May, 1852. 

16 Simons, Charleston J. viii. 364. 



240 PNEUMONIA AND 

house, a great number of Irishmen were employed in excavating 
the earth, and piling; that of these a great many were taken sick 
and died ; and that the sale and distribution of the earth through 
different portions of the city had a baneful effect. 1 The same correct 
observer states, in addition, that " in 1849 an extensive drain was 
opened in Hasel Street, excavating the most filthy and offensive 
materials ; and, likewise, an extensive drain in Market Street, from 
Church Street to the wharf. Yellow fever occurred earliest in 
those localities, and was more fatal. Again, the earth, so filthy and 
offensive, was transferred to King's Street, from Horlbeck's Alley to 
Hasel Street, and, in this particular spot, there was sickness among 
a class of persons who are generally exempt." 2 

For the following account of an extensive diffusion of autumnal 
fever from a kindred cause, which occurred in this country, we are 
indebted to an English writer, who collected the information on 
the spot. 

The digging of that part of the Chesapeake and Ohio Canal 
which runs from Seneka to Georgetown, commenced on the 17th 
of October, 1828, and was nearly finished in November, 1830. The 
distance is about twenty -three miles, and for the greater part the 
canal runs nearly parallel, and very close to the Potomac Kiver. 
The bank of the canal is elevated considerably higher, and, in some 
places, as much as fifty -four feet above the banks of the stream, 
which is there inclosed in a hilly country, and the water passes on to 
the ocean, with all the rapidity of a mountain torrent. During the 
summer of 1829, there were nearly four thousand labourers em- 
ployed in making this division of the canal. They continued 
healthy until the end of June ; but in July, August, and September, 
they suffered severely. During these months, two out of three were 
attacked with autumnal fever, most of them with its most aggra- 
vated form, and, as nearly as could be ascertained, of those that 
were taken ill, about one-fifth fell victims to the disease. 3 

All this is confirmed by what Lind pointed out, long ago — that 
" the effluvia from ground newly opened, whether from graves or 
ditches, are far more dangerous than those from the same swampy soil, 
where the surface is undisturbed ; nay, in some places, it has been 
found to be almost certain death for an European to dig a grave in 

i Ibid. 365. • 2 lb. 364, 5. 

3 Stevens on the Blood, 239. 



AUTUMNAL FEVERS. 241 

swampy districts of tropical climates, unless long seasoned to the 
country. In such a place, the attendance of friends at funerals 
ought to be dispensed with." 1 

The construction of the canal of the Ourcq, in France, in the 
years 1810-13, will long be remembered for the extensive pre- 
valence of fever, of which it was evidently the cause, and the 
large mortality which ensued at Pantin, and several other neigh- 
bouring villages. 2 We all have a recollection of the results attend- 
ing the digging of the Carondelet, and other canals in or near New 
Orleans, and in other parts of the country. 3 A memorable instance 
of this kind occurred in France in the latter part of the seventeenth 
century, on the occasion of the construction of the aqueducts and 
canals required for conveying water to Versailles from the Kiver 
Eure. The immense upturning of earth, which was effected during 
very hot weather, was followed by a large amount of disease and 
mortality all along the route, but more particularly about the Castle 
of Maintenon, where the principal works were constructed. 4 

Another instance of a more recent date, is worth recording. In 
the small commune of Lutzenbourg, in the arrondissement of Sarre- 
bourg, in France, the population of which did not exceed six hun- 
dred and twenty-five, remittent fever, preceded by a vast amount of 
ague, prevailed during July, August, and September, 1852. The 
spring had been cold and wet ; but about the first week of May, the 
thermometer suddenly began to rise. The heat steadily increased, 
and became intense in July. The disease, as well as the intermit- 
tents which preceded, were satisfactorily traced to the influence of 
the excavations and upturnings of earth required in the construction 
of the Paris and Strasburg Eailroad, which passes through the com- 
mune, and in cutting the canal connecting the Marne with the Khine, 
the bed of which, from the stoppage of the work, had been con- 
verted into a boggy marsh. "In proportion," says the reporter, "as 
the public works extended through (Sillonnaient) the valley, and by 
upturning the earth, brought up to the surface the deeper layers of 
the soil, so intermittent fevers arose and spread very extensively." 
Prior to this, the population had been healthy, and strangers to 
malarial fevers." ' 

1 Dis. of Hot Climates, 168. 2 Villerme, An. D'Hyg. xi. 352. 

3 Barton's Rep. to State Med. Soc. of Louisiana, 34. Thomas, 70, 1st ed. 

4 La Beaumelle, Mem. de Mad. de Maintenon, iii. 239, 240. 

5 Burchardt, Gaz. Med. de Strasburg, December 25, 1852, xii. 407. The esta- 

16 



242 PNEUMONIA AND 

I shall have occasion, as we proceed, to mention an event strik- 
ingly illustrative of the injurious effects of exhalation from open 
ditches, which occurred at the General Lying-in Hospital in York 
"Road, Lambeth. 

The following case, which is derived from Lancisi, 1 will be read 
with interest: On the first of May, 1707, the hilly grounds to the 
southward of the town of Bagnarea, after continued great rains, 
began to fall into the river which was near that town, in such a 
manner that whole vineyards were moved from their places, and 
some houses entirely, without falling ; in one of them, a woman 
was delivered of a child while the house was on its march. The 
channel of the river was choked and filled up. Many cracks, gaps, 
and holes were left in several parts of the ground, in which the 
waters stagnated ; and they, being impregnated with sulphureous 
minerals, with which the earth there abounded, became exceed- 
ingly offensive to the smell. During the summer heats, the colour 
of the inhabitants became of a dead swarthy yellow, and grievous 
pestilential fevers seized them. These were confined to the southern 
and lower parts of the town ; while the other parts, which stood 
high, and at a distance from the stagnating waters, out of reach 
of the vapour which arose from thence, remained healthy, as 
usual. By order of the magistrates, the channel of the river was 

blishment of the railroad from Strasburg to Basle, has required the digging, to the 
depth of 1 to 2 metres (from 8^ to 7 feet), of the adjacent fields, with the view of pro- 
curing earth with which to level the road. The results have been immense excava- 
tions in the vicinity of the communes of Bottwiler and of Feldkirch. After being 
filled with water in the autumn and spring, these excavations become partially dried, 
and deposit a large quantity of slime. They have thus been converted into true 
marshes, in which M. A. Boumann has discovered the characteristic plants of stag- 
nant water. 

Under the influence of this marshy surface the commune of Bottwiler, the popula- 
tion of which is 1446, has severely suffered from intermittent fever during the last 
three years. In 1842, the number of fever cases amounted to 36; in 1844, to 166 ; in 
1845, to 743 ; and in 1846, to 1166. The mortality has increased in the same propor- 
tion. The average in ten years (from 1836 to 1845) is 36. In 1846, it was not less than 
54. The small commune of Feldkirch, with a population of 450, suffered with equal 
severity. In 1843, the number of cases amounted to 2 ; in 1844, to 20 ; in 1845, to 135 ; 
and in 1846, to 376. (Dollfus-Aussat, Comptes Rendus de l'Acad. des Sciences, 1847, 
xxiv. 779.) M. De Gasparin stated, at the meeting of the Academy of Sciences, when 
this report was read, that similar effects were produced by analogous changes along 
the railroad of Tarascon. He added that, when informed of these facts, the Minister 
of the Interior ordered the marshes to be filled up. Archives, 4th series, xiv. 241. 

1 Nox. Palud. Effl. lib. 2, Epidem. iii. 210, 211. 



AUTUMNAL FEVEES. 243 

cleared, drains were made for carrying off the water, the places 
where it stagnated were cleared, and the cavities, which could not 
be drained, were filled up, and the inhabitants were the next 
summer freed from the fevers. 

In the public thanksgiving ordered for this deliverance, the 
Bishop declared the obligations they were under to Lancisi, by 
whose advice they had been delivered from such poisonous diseases. 

The injurious effects resulting from the receding of the sea, and 
the consequent extension of the land by the deposition of alluvion, 
have been noticed at the mouth of the Tiber, of the Po, of the 
Ganges, of the Oronoco, of the Mississippi, &c. The partial revolution 
which has taken place in the first of these localities, as is remarked 
by Dr. Carriere, has not resulted merely in pushing back inland the 
old city of Ostia, formerly the seaport of Kome, and separating from 
the sea the original mouth of the Tiber ; it has placed the city in 
the centre of an insalubrious territory, of which it formerly occupied 
only the edge, and has been the cause of its progressive depopula- 
tion. We know that formerly Ostia was too small for the number 
of its inhabitants, and figured among the magnificent cities of La- 
tium. At present, it contains only a priest, a tavern-keeper, four or 
five soldiers, and a few families, who do not venture even to reside 
there all the year round. But this insalubrity is not limited to the 
city; for, inasmuch as the miasmatic elaboration is effected on a 
large scale, in consequence of the increased extent of surface, there 
has arisen, since the time of the Eomans, a new source of morbific 
effluvia, which must be taken into account when we inquire into the 
sanatory conditions of the country, though more especially when the 
wind blows from the sea. 1 Another case in point is mentioned by 
Sir W. Burnett. In former days, there existed a large marsh near 
Mahon. It has now been converted into productive gardens. Since 
the draining of the greater part of this marsh has been completed, 
the sea has been gradually receding from the head of the harbour, 
leaving ( particularly during the prevalence of the easterly winds) 
a large portion uncovered, from which, in the summer and autumn, 
the most offensive exhalations proceed. 2 I have already alluded to 
the effect of the annual receding of the Nile. The same effect re- 
sults from the diminished extent, noticed every year at particular 
periods, in certain other streams and bodies of water, by which a 

1 Amer. J. July, 1851. Carriere, le Climat de l'ltalie, 20, 21. 

2 Fevers of the Mediterranean, p. 14. 



244 PNEUMONIA AND 

large portion of their banks is laid bare. The Eiver Biviere, and 
other watercourses in Sicily, lose, yearly, two-thirds or more of 
their dimensions ; Lake Cagiiari, in Sardinia, loses almost as much. 
All are hotbeds of fever. 

Beneficial effects of complete drainage. — On the other hand, while 
everywhere experience has demonstrated the injurious effects arising 
from the ordinary mode of cultivating rice — effects which have called 
forth in several places the protective interference of governments 1 
— the physicians of Georgia are ready to tell us what has been the 
result of the dry-culture system on the health of localities hereto- 
fore proverbial for their sickliness. 2 In New England, and other parts 
of this country, the removal of mill-dams has, as in other instances 
already mentioned, been found to produce the like salutary effects. 
Several of the cities of England and France formerly contained 
extensive portions of marshy ground, and other sources of miasmal 
exhalations, and were, in consequence, annually visited by remittent 
and intermittent fevers. Many of these marshes have been com- 
pletely drained, and the surface built upon, or otherwise improved, 
and the disease has disappeared. Thus, for example, in 1558, the 
mortality from such fevers in London was so considerable, that the 
living could hardly bury the dead. Less than a couple of centuries 
ago, that city was subject to the same disease, in its worst forms. 
Bishop Burnet's authority is cited for the fact, that, in the reign of 
Mary, intermittent fevers raged like a plague. 3 The same may be 
found in the writings of Sydenham and Morton. From 1661 to 
1665, the annual loss from intermittents alone averaged more than 
one thousand. Dr. Short informs us that among forty deaths from 
fever, between 1628 and 1636, one was from ague. "There are 
some diseases on the decline," he says. "Agues, whereof one of forty 
of the whole that died of fevers, died ; now scarce one of 1,100 that 
die of fevers, die of this. This distemper has at several times pre- 
vailed for a long series of years, and has sometimes raged like a 
plague. In 1664 they disappeared, and scarce came on the stage 
before '78 ; but from 1720 to 1729, they and remittents afflicted the 

1 Monfalcon, 160; Bourely, Gaz. Med.de Montpcllier, Oct. 1849, 99; ib Annates 
d'Hyg. xliii. 328, 332; Cycl. of Pract. Med. iii. 60; Williams on Morbid Poisons, ii. 
431 ; Boileau Castelnau, Annales d'Hyg. xliii. 331 ; Delongckamp, Diet, des Sc. Med. 
xlix. 56, 7 ; Zimmerman, de l'Experience, ii. 402 ; Fodere\ Med, Legale, v. 153. 

2 Daniel, 29. 3 Blane, i. 254, 255. • 



AUTUMNAL FEVERS. 245 

whole nation grievously ; and now, as to their severity, especially 
mortality, they are extinct." 1 Eemittents and intermittents consti- 
tuted, as it would appear, no inconsiderable an item among the dis- 
eases which Fothergill noticed in London during certain seasons in 
1751-4. 2 The immense marshes which were situate around the 
city, at Lambeth and other places, were removed by under-drains 
and sewers ; ditches were rilled up ; the river, which, from Lambeth to 
Woolwich, was swampy, was banked out, and the site rendered dry by 
being covered with buildings, and the most satisfactory changes in 
regard to salubrity were obtained. In 1728, the deaths from these 
fevers amounted to forty -four ; in 1729, to forty-seven ; and in 1730, to 
only sixteen. In 1752, the proportion was one in one thousand of 
deaths. For some sixty years, the disease has not been known as 
an endemic in that metropolis ; and of the few cases that occur, the 
larger number, if not all, are traceable to fenny districts, situate at 
a greater or less distance. 3 A similar improvement has taken place 
at Portsmouth, which, in former days, was a hotbed of intermittent 
fever; but has been freed of the disease, simply by paving the streets, 
and removing various sources of miasmal infection. 4 In England, 
according to recent reports, of the fifty cities and towns in which 
the mortality was highest, there was scarcely one in which drainage 
or sewerage was complete. In seven, it was indifferent, and in forty- 
two it was decidedly bad. Experience there has shown that no 
population is healthy which live amid cesspools, or upon a soil per- 

1 New Observ. Natural, Moral, Civil, Political, and Medical, on City, Town, and 
Country Bills of Mortality, &c. 208. Lond. 1750. 

2 Weather and Diseases of London.— Works i. 151, 210, 284. 

3 Dr. Good, and his commentator, Mr. Cooper, have called attention to the fact, that, 
in 1822 and 1823, agues again made their appearance, and have prevailed ever since 
more frequently than they had done for many years before, adducing this as a proof 
of the disease arising often from other causes than malaria. These cases, however, 
have prevailed principally on the outskirts and not the centre of the great metropolis. 
Besides, as respects London and its vicinity, changes have taken place sufficient to ex- 
plain the circumstance without negativing the existence of malarial effluvia. Dr. 
Copland, who is of that opinion, calls attention to the fact that "the streets have been 
macadamized, constantly watered, and covered by a wet, clayey mud ; the soil sur- 
rounding the metropolis has been turned up for the purpose of building, &c, to a much 
greater extent since that period than formerly ; and the muddy and marshy banks of 
the river have been unusually disturbed and inundated by the swell from the paddles 
of the numerous steam vessels." — Copland i. 1090, xVm. ed. 

4 See British & For. Med. B. i. 286. See, also, Baker on Intermittents, Med. Trans, 
of College of Phy. of London, iii. 141, &c. ; Willan's Reports, 203. 



246 PNEUMONIA AND 

meated by decomposing animal or vegetable refuse, giving off impu- 
rities to the air in their houses, and in the streets ; and experience 
has proved, also, that in those places where such sources of impu- 
rity are removed, the salubrity improves. From this, we may infer 
that a late writer is not far from the truth, when he avers that inter- 
mittents have nowadays become, to the profession at large, mate- 
rials for medical history, rather than for medical observation; since 
it is a rare fact, in many places, to meet with a case. If they appear 
at all, it is in marshy districts, some of which exist still, and must 
long continue to do so, or in such places as along the Surrey bank 
of the river — from Battersea to Deptford, where a great part of 
the surface is lower than high-water mark, and the ground conse- 
quently is never well drained. 1 

In the Island of Ely (England), the mortality, as compared with 
the births, was formerly as 70 to 61. The island has been drained; 
and we learn from Sir John Sinclair, that the proportion is now as 
54 to 61. Dr. Kirkland, who practised for thirty years at Chelm- 
ford, situate in a marshy district of country, called the Hundred 
of Essex, states that, in former days, the inhabitants were all pale, 
jaundiced, emaciated, and bore in every way strong marks of the 
effects of malaria. Fever prevailed extensively among them, and 
hardly any stranger could venture to the place. Through the 
instrumentality of philanthropic and enterprising individuals, the 
country has been drained, improved, and cultivated; fevers have 
disappeared or greatly lessened, and the inhabitants are as remark- 
able for their fine health and fine looks, as they were before for the 
reverse: 2 

Dr. Kigb}^, in his examination before the commissioners on the 

1 London Medical Gazette, xxiii. 876. 

- 2 Sinclair, The Code of Health and Longevity, 41, 42. London, 1829. 

Mr. John Marshall, Jr., in a report, says: It has been shown that the Isle of 
Ely was at one period in a desolate state, being frequently inundated by the upland 
waters, and destitute of adequate means of drainage; the lower parts became a 
wilderness of stagnant pools, the exhalations from which loaded the air with pestife- 
rous vapours and fogs ; now, by the improvements which have from time to time 
been made, and particularly within the last fifty years, an alteration has been made 
which may appear to be the effect of magic. By the labour, industry, and spirit of 
the inhabitants, a forlorn waste has been converted into pleasant and fertile pastures, 
and they themselves have been rewarded by bounteous harvests. Drainage, embank- 
ments, engines, and inclosures, have given stability to the soil (which in its nature is 
as rich as the Delta of Egypt) as well as salubrity to the air. — Chad wick, 2d Re- 
port, Eol. 



( 

AUTUMNAL FEVERS. 247 

state of large towns, 1 says of the General Lying-in Hospital, in 
York Eoad, Lambeth : " The hospital was seldom free for any 
length of time from puerperal fever, occasionally producing fright- 
ful ravages, and requiring the building every now and then to be 
closed. After the greatest attention had been paid to cleanliness in 
every respect, the wards left open night and day for weeks, fumi- 
gated, the walls limed and painted, the beds thoroughly cleaned, 
fumigated, repaired, and frequently renewed, and the most scrupu- 
lous attention paid to cleanliness, the fever reappeared, on some 
occasions immediately, on the hospital being reopened. This cir- 
cumstance made us look to external causes, when we ascertained 
that, in the immediate vicinity of the hospital, there were upwards 
of 1,500 feet of open ditches, receiving the drainage of the poor 
and dense population of the neighbourhood, one of the ditches 
being not more than thirty feet from the wall of the building. It 
was black and stagnant, and in constant ebullition from the dis- 
engagement of gas. After great difficulty and trouble, the hospital 
having to bear a large proportion of the expense, the Commission- 
ers of Sewers were induced, although with much reluctance (in Oct. 
1838), to have a portion of these ditches cleaned and properly 
arched over ; an immense quantity of black pestilential mud was 
excavated, but, instead of being removed, it was spread over the 
adjoining ground. The effect was, that " at that time the hospital 
was freed from disease, but ten cases of puerperal fever occurred 
within twenty-four hours after this unjustifiable act." The drainage 
of the hospital was then carefully attended to, and ventilation also 
(the main drain had been entirely blocked up by two logs of wood), 
and puerperal fever ceased. 

It appears, from the statistical accounts of Scotland, that the 
effects of drainage in various counties have been very beneficial to 
the health of the population. 2 There is not much intermittent fever 
in Edinburgh, but there was formerly a lock, called North Lock, 
which was famous for it. Ague, remittents, and intermittents pre- 
vailed in that district till the spot was drained. 3 They now no 
longer appear. The following facts are recorded in the Parliament- 
ary Eeports. In Fordown County: " So much draining that now 
no swamps ; formerly, agues common ; now quite unki 

1 First Report, 412. 

2 Second Rept. of the Lond. Commis. for 1848, p. 43. 
a Elliotson's Lectures, Lond. Med. Gaz. ix. 890. 



248 PNEUMONIA AND 

ross-Kinross : "Agnes prevalent sixty years ago, in conseqnence of 
marshes; now never met with." Oswell: "Agne prevalent for- 
merly, bat not since the land was drained." Eedgorton; "Healthy; 
no prevailing disease; agne was frequent formerly, but not since 
the land has been drained and planted." Albernyte : " Since the 
land was drained, scrofula rare, and ague unknown." " Muckhart : 
" Great improvement in agriculture ; ague formerly prevalent ; 
not so now." 1 

Mr. Smith states, in answer to questions put to him, at the re- 
quest of the Metropolitan Sanitary Commissioners, that in the 
alluvial clay district of Stirlingshire, and west of Perthshire, where 
the drainage was formerly effected by large open ditches, in the 
Dutch fashion, ague was periodically prevalent, and rheumatism, 
fevers, and scrofulous affections were much promoted, until the 
introduction of thorough drainage, forty years ago ; after which 
period those diseases began to disappear, or to be greatly mitigated 
in severity. " Few cases of ague now appear. Fevers are seldom 
known, except in the usual course of fevers which prevail epidemi- 
cally over the whole country. In the undrained condition of those 
districts, they were subject to dense fogs, especially in the autumnal 
months, when much rain had fallen, communicating a chilly feeling 

1 Dr. Southward Smith, before a committee of the House of Commons, declared : 
" That in every district in which fever returns frequently, and prevails extensively, 
there is, uniformly, bad sewerage ; a bad supply of water ; a bad supply of scaven- 
gers, and a consequent accumulation of filth. If you trace down the fever districts 
on a map of the Commissioners of Sewers, you will find that, wherever they have not 
been, the fever is prevalent ; and, on the contrary, where they have been, fever is com- 
paratively absent." 

In the Holywell and Long Alley district, with five hundred recorded cases of 
diarrhoea and typhus, within the last six months, in one particular place, namely, 
Long Alley — which is a long, narrow, and close passage, crowded with inhabitants — 
the drainage, contrary to the general rule, has been put in good order, and this 
place has remained exempt from disease. Two courts in Whitechapel, that were 
in an exceedingly damp and filthy condition, and in which fever had prevailed for 
some time in every house, ceased to be affected with disease on being drained. In 
Dulwich, fever was arrested by clearing out drains. In Hammersmith, diarrhoea dis- 
appeared in one street after the emptying of a cesspool that had overflowed, a new 
drain having been built at the same time. In the Acton district, no fever is reported, 
and only ten cases of diarrhoea, the external and internal cleansing having been well 
attended to. — -Metropolitan Sanitary Commission, 2d Report (1848), 22. 

"It is reported to us that agues and remittent fevers, in Gravesend and the vici- 
nity, have been greatly reduced after the drainage, although very imperfect, which 
has been accomplished in the town and neighbourhood. — Id Report of London Com- 
missioners (1848), 42. 



AUTUMNAL FEVEES. 249 

to the inhabitants ; but since the general introduction of thorough 
draining, those fogs seldom prevail, unless in a general foggy tend- 
ency of the atmosphere of the country." 

On the farm of Deanston, in the west of Perthshire, consisting 
of about 200 acres, and which was the first farm on which the entire 
system of thorough drainage and subsoil ploughing was introduced, 
there was a marked effect produced. The farm, after periods of 
rain, used to be covered with chilly fogs, which entirely disappeared 
after the thorough draining was effected. 

Mr. Parker reports : " In respect of increased salubrity, induced 
in towns and rural districts by drainage, I may instance the 
acknowledged disappearance of ague and other periodical maladies 
consequent on the great drainage effected in Cambridgeshire, as in 
the Isle of Ely, &c, and in the Lincolnshire, and other great 
marshes. As an example of the good effects arising from the 
drainage of swamps, I may state that the Commissioners of Her 
Majesty's Woods and Forests, of which your lordship is the chief, 
have recently caused me to drain an extensive tract of country in 
the new forest, called the Wear's Lawn and Bog, adjoining which is 
a small hamlet, where inhabitants previously suffered much from 
intermittent fevers. The hamlet is now healthy; the offensive, 
gaseous emanations from the soil have ceased ; and the inhabitants 
are supplied with an abundance of the purest spring water, dis- 
covered during the operations of drainage, and appropriated to 
their use." 

A Mr. Neilson remarked: "I have also had several opportunities 
of witnessing similar effects in the West Indies, and particularly in 
British Guiana, where I resided several years. The surface is 
almost a dead flat, lower than the sea at high water, and drained 
only at considerable expense by large sluicegates for each estate, 
which are opened each period of low water. When an estate is 
abandoned, this is neglected, and its. neighbourhood is invariably 
the first to suffer on the approach of an epidemic; and I have 
known instances of the course of a fever thus produced being 
checked, and materially altered, by the neighbouring lands being 
drained, an alteration considerably accelerated by a small quantity 
of lime, in a finely powdered state, being distributed on the lands 
during a windy day." 1 

1 Drainage of the Land Forming the Sites of Towns, 69-72. London, 1852. 



250 PNEUMONIA AND 

According to Dr. Graves, whose premature loss to the profession 
we must all greatly deplore, there can be no doubt that in Ireland, 
as in other countries, the effects of cultivation and drainage on the 
health of the inhabitants are very remarkable. He himself witnessed 
several exemplifications of the improvements thus effected in respect 
to the public health. Formerly, ague was of rather common occur- 
rence in some marshy districts in the immediate vicinity of Dublin, 
and consequently, when he was a pupil, cases of intermittent fever 
were constantly to be met with in the hospitals; now, the low 
grounds have been drained, and thus the production of ague has 
been entirely arrested. 1 

The city of Cork, Ireland, lies in an irregular valley which is 
open to the east and west, but is confined by hills on the north and 
south sides. On the west it is connected with the fertile valley of 
the River Lee, which, rising from the mountain lake of Gongane 
Barra, flows in a devious course until it reaches the city of Cork, 
where it receives a large tidal accession. When the Lee is about 
a mile west of the city, it divides into two channels, which gradually 
diverge, but reunite again, thereby insulating a considerable tract, 
upon which the main part of the city is built. This tract is low, 
and being permeated by some small streams from the main 
branches, inundations occur when the river is swollen by heavy 
rains and high tides. From this cause the city anciently derived 
its not very flattering name, Corkagh, signifying a morass. This 
unpromising locality, from its marshy nature, was, as might be 
expected, very subject to intermittent fever, and "the fever and 
ague" were as familiar words in Cork as they are in the swamps of 
the Mississippi. Within the last century it has been drained, and 
in part built upon. The .smaller inosculating channels have been 
arched over ; the river has been confined by handsome quays to its 
two divisions, and the main branches have been deepened. The 
effect has been, the almost disappearance of the fever, which now 
shows itself but seldom, and for a number of years did not reign in 
an epidemic form. 2 

In fact, so far as Great Britain is concerned, the immense benefit 
of drainage has been proved by all the researches of Mr. Chadwick, 
who says : " In considering the circumstances external to the resi- 

1 Clinical Lectures, 51, Am. ed. 

2 Popham, Notes on the Climate and Diseases of the City of Cork, Dublin Journal 
of Med. Sc. xv. 290, May, 1853. 



AUTUMNAL FEVERS. 251 

dence, which affect the sanitary condition of the population, the 
importance of a general land drainage is developed, by the inquiries 
as to the causes of the prevalent diseases, to be of a magnitude 
of which no conception had been formed at the commencement of 
the investigation; its importance is manifested by the severe conse- 
quences of its neglect in every part of the country, as well as by its 
advantages in the increasing salubrity and productiveness, wherever 
the drainage has been skilful and effectual. 1 

Lancisi gives a memorable instance of this in the town of Gron- 
dolpho, already referred to, which, notwithstanding its elevation, 
was rendered sickly by the exhalations from Lake Turnus, lying 
below it to the south-west. The lake was dried up, by order of 
Pope Paul V., and salubrity was the consequence. 2 The same 
writer relates an interesting case of the beneficial effect of drainage, 
which was communicated to him bj Lentilius, physician to the 
Duke of Wurtemberg, and which occurred at Stutgard. " "What 
you are preparing, on the noxious exhalations of marshes," says 
Lentilius, " cannot but be entertaining and useful. No one can 
doubt of the great importance of the subject. This I can illustrate 
by a single statement : Stutgard, the residence of my most serene 
Prince, is surrounded by mountains on every side except the east, 
where there is a sort of plain, stretching about an hour's walk 
towards the Eiver Necker. Near the wall of the town, on the 
eastern side, and near that plain, was formerly a fish-pond or pool 
of several acres in extent. For many years, our metropolis has 
been notorious for its obstinate quotidian intermittents, which, 
being scarcely epidemic, but only endemic, have been commonly 
known by the name of the Stutgard fevers. It happened, about 
fifteen years ago, that this pool was drained, and converted into a 
most beautiful meadow. From that time, intermittent fevers have 
become so rare that they never once have deserved the name of 
epidemic, but only appear in sporadic cases, here and there, and 
are, moreover, much easier to cure. Hence, it appears that the 
fevers arose from the filthy effluvia of the pool, wafted by the 
eastern wind over the town, and confined there by the inability of 
the wind to sweep them quite away, on account of the mountains 
adjacent." 3 

1 Second Kept. Fol. 

2 De Noxiis Palludum Effluviis, 20. 3 Ibid. 10. 



252 PNEUMONIA AND 

M. Huguenin, in a Prize Essay on Ponds, which was presented 
to the Academy of Lyons in 1778, and is quoted in the Memoirs 
of the Koyal Medical Society of Paris (vol. viii. p. 289), after dwell- 
ing on the injurious influences of marshes, says: "Lorraine long 
experienced these baneful effects, before the cause of the periodic 
return of the fatal febrile diseases, by which it was visited during 
several successive centuries, could be ascertained. While its hu- 
mane and benevolent princes founded thousands of charitable insti- 
tutions to insure relief against these ever-renewed evils; while 
natural philosophers and physicians laboured to discover the germ 
of those disastrous epidemic diseases, agriculture came to the aid 
of this desolated province, and, without suspecting the miracle it 
was about performing, drained, in a short time, two hundred ponds, 
in order to fecundate the precious soil which had so long been ab- 
sorbed by the water. The air being thereby relieved of the humid- 
ity and putrid vapours by- which it had been heretofore saturated, a 
stop, or at least an interruption, was put to this fatal circle of con- 
tagions, which, while endemic in localities surrounded by ponds, 
appeared often epidemically in the rest of the province." 

In Paris, malarial fevers, in the time of Ballon ius, were of daily 
occurrence, and prevailed on a large scale. They have now become 
so rare that when Alibert wrote his once popular treatise, it was 
with' difficulty he could find more than a few cases for examination. 
Strasburg, already mentioned, has, in like manner, been cured of 
such diseases, except in some parts of the suburbs; but here, 
marshes have been allowed to remain unreclaimed. Like results, 
though not invariably so entirely satisfactory, have been obtained 
in other parts of France; as, for example, at Eochefort, Marenne, 1 
Bresse, 2 Lome, 3 Bourg, 4 Monbrison, 5 Feurs, 6 Lyons, 7 Bourgoin, 8 &c. 
If the first of those cities — which, in the days of Chirac, was pro- 
verbial for its unhealthiness, and was visited, in 1694, by a wide- 
spreading and malignant epidemic, of which that most distinguished 
physician has left us a vivid description — still suffers from fevers in 
autumn, the effect is due, not to the persistence of palludal influ- 
ences within its walls, or in the immediate vicinity, but to other 
circumstances already adverted to. 

1 Melier, Mem. cle l'Acad. de Medecine xiii. 673. 

2 Statistique du Depart, de l'Ain, 184; Fodere, Mdd. Legale, v. 251. 

3 Gaultier de Claubry, Mem. de lAcad. de Me"d. xiv. 129. 

4 Monfalcon, 32. 5 lb. 42. 6 lb. 184. 7 lb. 182. 8 lb. 182. 



AUTUMNAL FEVEES. 253 

The present beautiful city of Bordeaux was so sickly formerly — 
so frequently and fearfully visited by periodic fevers, arising from 
the exhalation of extensive marshes, situate in the vicinity — that 
the Parliament of the Province, which held its meeting there, was 
often compelled to seek shelter in other and more favoured locali- 
ties. Such was the case in 1473, 1495, 1501, 1515, 1525, 1546, 1653, 
and 1654; on which occasions, the disease assumed a more malignant 
form than common, and was, according to the custom of the times, 
held in the light of a plague. Similar events would, probably, have 
continued to occur, had not a venerable prelate, the Cardinal de 
Sourdis, then bishop of the Province, formed, in 1604, the project — 
which he carried into effect at his own expense — of draining and 
reclaiming the larger portion of the marshes situate near the city. 
This gigantic work was effected ; and fevers, since then, have seldom 
if ever visited that city — never, in that part of it which had been 
more particularly under the influence of the culprit marshes. Other 
similar works, in other parts of the city or the vicinity, have been 
effected, and always with the same happy results. 1 

1 Betbeder, Topogr. Med. de la ville de Bordeaux, Mem. de la Soc. Roy. de Med. 
i. 187 ; see also same work, viii. 279 ; Yillerme, An. d'Hyg. xi. 349. The ponds of the 
Dombes, as already mentioned, have long been noted for the insalubrity they occasion. 
In 1839, the sickness in the vicinity was so great that a commission was appointed 
to suggest measures for remedying the evil. In his report on the subject, M. Purvis 
says : " Almost every individual examined admitted the baneful effects of the ponds : 
a large number viewed them as the principal cause ; a small number referred the 
effect to the nature of the soil ; others, to the marshy condition of the fields, &c." 
At the same time, a large amount of facts were adduced in the course of the inquiry, 
tending to show that the salubrity of the place was restored whenever the ponds were 
dried up. The commission, in view of the numerous facts obtained during the inquiry, 
— influenced by the advice of all the physicians who have turned their attention to 
questions of public health, and of all the agriculturists and economists who have 
written on the subject — taking into consideration that the Dombes, before the increase 
in the number of ponds, was much more extensively cultivated and more populous than 
since they have been made to occupy a large portion of the soil ; that since then 
more than one-half of the population seem to have disappeared; that while the Bresse, 
the formation of which is similar to that of the Dombes, with an inferior and unhealthier 
soil, has, by drying up its ponds, enhanced its prosperity, and possesses now a popula- 
tion of 1,600 inhabitants to every square league ; the Dombes, on the contrary, by 
multiplying hers, has lessened greatly the net value of her agricultural products, and 
has now a population of less than 400 to the square league ; — considering, finally, that 
insalubrity and fevers reappear everywhere with the increase of ponds, and that com- 
monly salubrity is everywhere restored when these are dried up, the commissioners 
are unanimous in the opinion that the ponds are, without the least doubt, the princi- 
pal cause of the insalubrity of the Dombes." They admit that marshy fields, bad 



254 PNEUMONIA AND 

Surrounded as Copenhagen and all Denmark are by water, salt 
and fresh, and situate, as the former is, in a low and flat country, 
containing much stagnant water and many ditches, it is no wonder 
that ague is of very common occurrence there. Yet the disease, as 
we learn from Professor Otto, "is much less frequent now than 
formerly, which must be attributed to the draining of several pools 
and stagnant waters. The ague was, at one time, from the want of 
proper drainage, extremely frequent, and in many cases fatal, on 
the island of Langland." 1 

Around Scanderoon, the seaport of Aleppo, are extensive marshes 
and swamps, which produce their usual effects. " During the sway 
of Ibrahim Pasha in the country, it was brought before his notice. 
Attracting as it did so much attention, the whole was drained, and 
canals formed to carry off the waste water continually from the 
hills, &c. For two years subsequent to the completion of these 
salutary exertions, an almost perfect immunity was enjoyed ; but 
the soldiers, at the commencement of the operations in 1840, de- 
stroyed the embankments, &c, and soon reconverted what had 
become cultivated land into their former state, and the disease, 
which had almost been banished from the neighbourhood, again 
resumed as severe a sway as formerly." 2 

As cities enlarge and improve, malarial fevers decrease in them. — In 
our own cities — the larger ones particularly — remittent and inter- 
regimen, and, perhaps, the nature of the soil, have some agency in producing that 
effect ; but they believe that all those causes combined are far from being capable of 
occasioning a degree of evil equal to that occasioned by the ponds. (Statistique du De- 
partment de l'Ain, quoted from Becquerel on Climate, 278.) The commune of Varenge- 
ville, in the arrondissement of Dieppe (Seine Inferieure), is situate on a surface which 
formerly constituted part of a large marshy district noted for its unhealthiness, and was 
the frequent seat, during the autumn, of epidemics of intermittent fever. On one 
occasion, the almost entire population — 177 out of 182 — suffered simultaneously or 
in succession. Their general health was bad ; they presented signs of a cachectic 
state, and all the morbid conditions resulting from frequent attacks of intermittent 
fever. The duration of life among them was short. Considerable ameliorations have 
been effected in the condition of this locality during the last sixty years. A great 
part of the marshy surface has been drained and converted into cultivated fields, and 
periodic fevers have diminished or disappeared. In some parts, however, and espe- 
cially in the small commune of Varengeville, little or nothing has been done to reclaim 
the land and marshy surfaces, and stagnant pools continue to exist ; and wherever 
such is the case, fevers continue to prevail. (Mem. de l'Ac. de Med. xiv. 118.) 

1 Topogr. of Copenhagen. Trans, of the Provincial Med. and Surg. Assoc, vii. 205. 

2 Robertson, Med. Notes on Syria, Ed. J. lx. 38. 



AUTUMNAL FEVERS. 255 

mittent fevers are limited to the suburbs. As the buildings extend 
out, and the closely inhabited portions expand, and, by so doing, 
lessen the area of humid and exposed soil, the disease recedes. 
Charleston, Savannah, New York, Buffalo, Auburn, Geneva, Syra- 
cuse, Salina, and Louisville, &c. may be appealed to in illustration 
of this. The statement of Professor Yandall, relatively to the latter 
city, are apposite. The rock, of which the subsoil is composed, 
" forms a surface remarkable for its evenness ; and the soil which it 
produces, as it crumbles under the action of the air, frost, and water, 
is peculiarly retentive of moisture. Ponds and slushes are abund- 
ant, wherever the black slate constitutes the surface-rock. The 
first houses erected at the fall were built in the midst of ponds. 
Entire squares of the city are now pointed out, which occupy the 
ancient beds of ponds, large and deep enough to float a steamboat. 
These have all been drained, and such collections of water are no- 
where to be seen within the city limits." Louisville, while it stood 
amid its ponds, Dr. Yandall remarks, " was regarded as one of the 
most sickly towns in the Yalley of the Mississippi. It was com- 
monly called ' The Graveyard of the West. 1 It is now esteemed one of 
the most healthy. Intermittent fever was a regular annual visitant, 
and occasionally a form of bilious fever prevailed, rivalling yellow 
in malignity, and threatening to depopulate the town. The most 
fatal of these endemics broke out in 1822, after a hot, rainy season. 
The number of victims from it, out of a population of less than five 
thousand, was two hundred and thirty- two. In a family consisting 
of twenty persons, nineteen were sick at one time, and, in some 
families, every individual died. At this time, only one street in 
Louisville was paved, and within its limits were at least eight ponds 
of greater or less dimensions, most of- which, in the course of the 
autumn, were dried up, exposing foul bottoms to the sun. " The 
ponds have all disappeared. The streets have generally been 
paved, and, though the grading is defective, and can never be as 
effectual for drainage as it might be rendered on a less even sur- 
face, still, it is such as to carry off the rains into the river, and the 
ditches south of the city. The only parts of Louisville obnoxious 
to the charge of unhealthfulness, are its suburbs. Beargrass, a 
small sluggish stream, with alluvial banks, which empties into the 
river at the foot of Third Street, taints the air in its neighbourhood. 
The ponds send up their effluvia from the south ; and the extended 
rocks of the falls, laid bare by the retreating river in dry seasons, 



256 PNEUMONIA AND 

exhales the poison of intermittent fever. The inhabitants along 
the Beargrass, and of Water Street, and of the scattered dwellings 
in the outskirts of the city, are sorely afflicted with the fever. The 
infected circle is receding. In 1837, it was not deemed safe to re- 
side nearer the limits of the city than Walnut Street. Now, Chest- 
nut Street is considered healthy. As we go from the suburbs 
towards the crowded parts, the chances for health increase, and, as 
the new streets are built up, a barrier to the fever poison is thrown 
around the older neighbourhoods." 1 

If the reader desires to have another convincing proof of the 
cessation of the production of autumnal fever from changes of the 
kind mentioned, let him come and see what has been the result in 
Philadelphia. In former days, when the city was of limited ex- 
tent — with few improvements — with buildings scattered about, and 
leaving open and unimproved spaces between them — with a marshy 
stream running through the greater part of it — with ponds, natural 
and artificial, spotted over the plot in various directions, and with 
unpaved streets — fever was of common occurrence, and epidemics 
were not unfrequent. At present, malarial fevers are unknown in 
the city proper, as well as in the compactly built and well-drained 
portions of the suburban districts. If we wish to meet with them, 
we must go to the outskirts of these districts, or to some distance 
from them, to the open meadow ground of the neck, or to other 
unimproved surfaces of the vicinity ; but, more particularly, to the 
marshes which still exist along the river banks. 

Our townsman, Dr. Emerson, who has devoted considerable 
attention to the subject of public hygiene, and furnished several 
excellent essays on the vital statistics of Philadelphia, has conclu- 
sively shown that the influence of the sickly air is expended upon 
the comparatively limited portion of the population living in the en- 
virons and outskirts of the city. During the periods embraced in his 
calculations — and the same holds good in all other times and places 
— the fever, in some of its forms, was almost universal ; whilst, in the 
more dense and well-paved parts, the air seemed unusually healthy; 
and where remittents and inter mi ttents were met with, they could 
almost invariably be traced to exposure to night air in the country 
or suburbs. Never, he remarks, was a stronger demonstration 

1 Sanitary Condition of Louisville; Trans, of Med. Assoc, ii. 611, 612: see also 
Drake, 249. 



AUTUMNAL FEVERS. 257 

afforded of the resistance made by cities to the influence of country 
malaria, than our late experience has furnished. Great as was the 
amount of sickness during the epidemic of 1822 and 3, it was con- 
fined almost entirely to the comparatively small proportion of 
population inhabiting the unpaved or ill-payed environs. " Our 
observation," Dr. E. adds, " on this and other occasions, has led us 
to ascribe this exemption, for the most part, to the pavements, 
which, by effecting a perfect drainage, prevents exhalation, at the 
same time that it admits of the total removal of vegetable and 
animal matters, the sources of foul and unhealthy emanations. 
The chief motive for paving the streets and sidewalks is usually 
convenience ; but it has always appeared to us that by far the 
most important object achieved by it was the preservation of 
health." 1 Since the time to which this has reference, thirty years 
have elapsed. In the interval, the compact, dense, and well-paved 
parts have extended far beyond where they were then, and with 
their expansion the disease has receded. 

Hear what a physician of the middle of the last century says : 
" When I first came into this city, the dock was the common-sewer 
of filth, and was such a nuisance to the inhabitants about it, that 
they were obliged to use more pounds of bark, than they have 
ounces, since it has been raised and levelled." 2 

Hear also what Dr. Bond's distinguished contemporary, Cadwal- 
lacler Colden, states : "I remember that several years since, when I 
was at Bristol, Pa., opposite to Burlington, which is situated to the 
northward of a large space of swamp ground, they told me that 
they had been, from the first settling of Bristol, subject to inter- 
mittent fevers of a malignant kind; and, indeed, the aspect of the 
inhabitants showed the ill effects of the air which they breathed. 
While I saw them, they assured me, at the same time, that not 

1 Amer. J. ix. 27. 

2 Bond's Introductory Lecture, delivered at the Pennsylv. Hospital, Dec. 17, 1776; 
N. A. Med. and Surg. J. iv. 270. 

During the winter of 1849, 1850, the New Orleans city authorities ordered all the 
timber standing between the city and the Metairie ridge — an elevated space between 
the city and lake, in the midst of a cypress swamp — to be cut down. The greater 
part of the ground was also well drained. By this means, an extensive swamp was 
dried up by the rays of the sun, and the obstruction to free ventilation, by the breezes 
of the lake, removed. Writing a year after, Dr. Fenner says : ''I think it not at all 
improbable, that this work has already exerted a beneficial influence upon the health 
of the city." — Southern Medical Reports, ii. 88. 

17 



258 PNEUMONIA AND 

above two or three children, born in that village since its first set- 
tling, had attained to the age of maturity ; but since that time, 
these swamps having been drained and converted into profitable 
meadow grounds, I am informed that Bristol is, in a great measure, 
freed from these annual epidemical fevers." 1 Speaking of Cahawba, 
Ala., Dr. English states that the land in the immediate vicinity of 
the town is low and flat, and was, until 1840, interspersed with 
numerous small shallow ponds. These have been thoroughly 
drained, and now hold water but a few hours after the heaviest 
rains. It has become a subject of remark by the citizens of the 
place, that since that time the town has become much more healthy, 
particularly as regards endemic fevers. In truth, in the last four 
or five years, the former dreaded scourge, bilious remittent fever, 
has almost disappeared, and the few cases that do occur are of a 
mild type. 2 

Beneficial effects obtained from the draining of marshes prove the 
existence and morbific agency of malaria. — Large portions of the Tuscan 
and Luccan Marshes, the maremmes of Albagna, of Ombrone, Gros- 
setto, Orbatello (between Sienna and the sea), Campilla, Piombino, 
Castiglione, the val di Chiana, 3 have been reclaimed ; the soil has 
been improved, and applied to useful purposes, and there sickness 
has disappeared. The reader will find,- in Tozetti's travels in Tus- 
cany, 4 an interesting account of the important changes effected by 
the Grand Dukes Cosmo I. II. and III., and Ferdinand I. and II., 
with a view to reclaim the marshes, and destroy the insalubrity of 
the country around Pisa, and of the satisfactory results thereby 
obtained. At a later period, under the direction of Gaetano Geor- 
gini, and by order of Dukes Leopold I. and II., the principal basins 
of the Tuscan Maremmes were drained, and otherwise improved, and 
there, as was expected, fevers have disappeared, and the population 
has sensibly increased. The town of Massa, which, for years, was 
noted for its insalubrity, was completely restored to a healthful con- 
dition by the draining of a large and deep marsh, situate on the 
north-east of it. By means of a canal, constructed through one 

1 Med. Kegist. i. 323. 2 N. 0. J. vi. 1G8. 

3 Fossombroni, Memoires historiques ct hydrauliques sur le val de Chiana, 1780 ; 
Tartini menaorie sul beneficiamento delle Maremme Toscana, 213; Carriere, 325. 

4 Voyage Mineralogique, Philosophique, et Tlistorique en Toscane, par le Dr. J. T- 
Tozetti, i. 392. 



AUTUMNAL FEVERS. 259 

side of the hollow, the water escaped, the marsh was drained, and 
the morbid effect was arrested. A few years after, the canal, which 
was too small, being choked up, the surface once more became 
marshy, and fevers reappeared; but, in 1829, the same canal was 
cleansed and widened ; the soil was again dried ; fevers once more 
ceased to prevail, and the city has, since then, remained healthy. 1 

As regards the Luccan Marshes improvements had been effected 
in them as early as 1741, when one of the three basins, into which 
they are divided — the Massaciuccoli — the most unwholesome of all, 
was drained. The success was so complete that fever entirely ceased. 
In 1768, 9, the sea-water, owing to a derangement in the locks, 
once more covered the reclaimed land. As a, natural consequence, 
marshes were reformed, and, with these, the disease reappeared. 
The mortality at Viareggio, and the adjacent parishes, which the 
year before had not exceeded one in forty of the population, 
amounted now to one in fifteen (170 in 1330). The locks were 
repaired, and health was re-established. In 1784, 5, a like accident 
in the locks occurred, and the same results followed — fever returned. 
In the former of these years, out of a population of 1,898, 1,200 
were attacked, while the number of deaths was 92, or 1 in 20 of 
the whole amount of the inhabitants. In 1785, 103 died, out of a 
population of 1,834, or 1 in about 18. Again, the locks were re- 
paired, the sea was excluded, the marshes were dried up, and health 
was once more restored. Other portions of these pestiferous 
localities were reclaimed in 1812, 1819, and 1821, and everywhere 
the success has been equally satisfactory. 2 Need I add that, with 
the diminution or cessation of fever, the population has increased? 
At Grosseto alone, from 1814 to 1843, the augmentation has been 
from 53,175 to 76,179. 3 In Viareggio, the number of inhabitants 
in 1733 was 1,509 ; in 1823 (90 years), it had increased to 9,408. 4 

On the opposite effect, the following remarks of Lancisi deserve 
attention : — 

" And we, taught by the calamities of the noble and crowded 
cities of Italy, which have been desolated by the marshes alone, 
behold with our own eyes the mischiefs occasioned by stagnating 
waters, without looking abroad for the reasons or inquiring for the 

1 Carriere, Le Climat tie l'ltalie, 824, 5 ; Salvagnoli, Saggio delle Statistica medica, 
dclle Maremrae Toscane. 

2 <jiordini, An. de Chemie, &c. xxix. 225. 234; Melier, op. tit. 686. 

3 See Carriere, 333. 4 Giordini, op. tit. 237. 



260 PNEUMONIA AND 

evidence of other persons. Aquileia, for example, formerly in a 
most flourishing condition from the number of its inhabitants, even 
so much as to merit its advancement, first to a metropolitan and then 
to a patriarchal dignity, scarcely retains at this day the remains of 
houses, or any traces of its former splendour ; and the sole cause of 
its overthrow has been the contamination of the air from undrained 
waters. The city of Brunclusium, formerly so famous, is lament- 
ably mentioned by Antoninus Gralatheus, in words which, by reason 
of their aptness, we quote : 'Moreover, cities situated in a healthy 
climate have been destroyed. Cities, indeed, like men, have their 
vicissitudes. But the neglect of its inhabitants has been the ruin 
of Brundusium ; for had outlets been made for its waters, it would 
never have acquired such an unhappy distinction.' m 

The effects of covering sickly places with water lead to the same belief. 
— But draining, improving, and cultivating the surface of infected 
localities are not the only modes of putting a stop to, or greatly 
diminishing, the prevalence of fever, and thereby proving the fact 
that these must arise from a cause exhaled from the soil. We have 
seen, on the authority of Pringle, that, during the campaign of 
1748, in Brabant, the country bordering on the lower part of the 
Maas, was rendered more unhealthy, upon letting off part of the 
water by which the country around the fortified towns had been 
submerged. It may now be proper to add, from the same author, 
that the "States of Holland, being made sensible of the sickness 
which raged at Breda, and in the neighbouring villages, gave orders 
to let in the water again, and to keep it up till winter." 2 Indeed, 
experience taught Pringle that, "as to cantonments in marshy 
grounds, if the troops must remain there in the dangerous season, 
it will be better to float the fields entirely, than to leave them half 
dry." 3 The same process was resorted to some years ago, with 
complete success, at Paris, Bordeaux, and other parts of France, 
and is never neglected there, when marshy surfaces cannot be 
otherwise reclaimed. 4 "We have already seen the means adopted 
to correct the blunders of the revolutionary government, in 1793. 
Blane informs us that, while the British troops were suffering from 

1 Lancisi, op. cit. lib. i. cap. iii. 8; see also Dr. Mitchell's Tr., Med. Repos. xiii. 16. 

2 Pp. 61, 62. 3 Ibid. 98. 

4 Parent du Chatelet, An. d'Hyg. xi. 310; Fleuriau de Bellevue, Comptes Rendus 
de l'Acad. des Sc. xxv. 338, 9. 



AUTUMNAL FEVERS. 261 

the Walcheren fever, " the native inhabitants affirmed they were 
less sickly than usual at the same time, owing, as they said, to the 
unusual quantity of rain that had fallen during the two or three 
preceding months." 1 

Indeed, the beneficial effects obtained from the flooding of marshes 
or insalubrious surfaces, by artificial means, by freshets, or otherwise, 
have been noticed from time immemorial, as well in foreign coun- 
tries, as in our own. 2 The practice is certainly not new, and may 
be traced to an early period in the annals of hygiene, as the reader 
will find by reverting to the history of Empedocles, who delivered 
the inhabitants of Salimonte of the effluvia exhaled from the 
marshy banks of the neighbouring rivers, by causing these to be 
flooded by means of the pure water of other streams. In many 
of the islands of South America, on the coast of Mexico, at Ba- 
tavia, in Africa, in the East and West Indies, in Europe, and else- 
where, sickness, as we have seen, prevails at the commencement 
and close of the rainy season, and ceases completely, or in great 
measure, when the rivers are high, arid the marshes, swamps, as 
well as the country generally, are covered over with water. 

More than a century ago, Desportes expressed himself in favour 
of the opinion that yellow fever arises often from the foul condition 
of ships, and attributed the escape of a vessel, the Jason, of seventy- 
four guns, in 1746, at St. Domingo, to its extremely leaky condition, 
by which the sources of exhalations in the hold were submerged. 3 

The common saying of the sailors, that a leaky ship is ever a 
healthy ship, is well known; and, in conformity with the result of 
experience on that point, the submerging or sinking of infected 
vessels has not unfrequently been resorted to as a means of puri- 
fication. 

The practice is noticed, as extremely useful under peculiar cir- 
cumstances, by Lancisi, who was too clear an observer not to have 
discovered that marshes are "harmless, when plentifully diluted and 
cleansed throughout by pure and fresh supplies of water." Lancisi 
reminds us, too, of a fact mentioned centuries ago, by Strabo, 4 and 
which has been already briefly alluded to : "Alexandria, in Egypt, 

1 Dissertations, i. 219. 

2 Carriere, loc. cit. 526 ; Ludlow, N. Y. J. ii. 84 ; Caldwell, Essay on Malaria, 75 ; 
Villerme, An. d'Hyg. ii. 349. 

3 Histoire des Maladies de St. Domingue, i. 1G2. 

4 Geographia, lib. xvii. 278. 



262 PNEUMONIA AND 

stands near the marshes ; and although it ought to experience, 
during the scorching heat of summer, a close and suffocating air, 
yet, by the seasonable rise of the Nile, nothing filthy exists whence 
vitiated exhalations can arise, especially when the Etesian winds 
begin to blow from the north, and arrive after sweeping a wide 
tract of sea." 

The surface now covered by the city of Rome, as well as that over 
which was spread the ancient mistress of the world, and the adjacent 
campagna, could scarcely fail to be, to a certain extent, insalubrious 
in olden times ; but, from all we can collect on the subject, it would 
appear to have been less so formerly than it is at the present day. 
When limited to a few hills, the Quirinal, the Palatine, and the 
Capitoline, marshes of large size — the great and little Yelabrum — 
existed in the close vicinity. At no great distance, were other 
marshes, the Capuan, and those of Tarentum. Then there were 
the Lakes of Castiglione and Giuturna, besides smaller lakes or 
pools situate all about the Roman territory. Most of those locali- 
ties, though now uninhabitable, were then populous, and, in all 
probability, owed their greater salubrity to the fact that the larger 
number of those receptacles of water, which were then completely 
filled, have been partially drained by artificial means, or filled up 
by the gradual increase of their subaqueous soil, and retains be- 
neath the surface the water by which it was once covered. 

The following fact, already adverted to, illustrates more than one 
of the results here mentioned : " It has been remarked by persons 
who live in the vicinity of Morne Fortune (St. Lucia), that when the 
military, who inhabit the Morne, suffer severely from sickness, the 
inhabitants of the town of Castrie (in the close vicinhvy), are gene- 
rally in good health ; and, on the contrary, that when the inhabit- 
ants of the town are sickly, the garrison on the height is compara- 
tively healthy. The Morne is a bog in wet weather ; Castrie is 
then an inundated swamp ; in continued dry weather, the Morne 
has a hard and firm surface ; Castrie is then a swamp advancing to 
exsiccation. The fact is obvious, and presents itself as a cause of 
what takes place." 1 All these facts, as also the stoppage of febrile 
epidemics by a profuse fall of rain, are, besides many referred to 
under another head, attested by the most reliable authorities. 2 

1 R. Jackson, Sketch, ii. 358, 9. 

2 Bally, 309; James Johnson, 43, 320, 330; McWilliams, 184; Pritchett, 108; 
Boyle, 3, 123 ; Dazille, 10; Desportes, i. 52, 80, 87; Firmin, 3, 17; Gillespie, 137; 



AUTUMNAL FEVERS. 263 

To the same effect may be cited the beneficial results obtained 
in France and elsewhere, by the filling up of ditches and other 
excavations — remarkable examples of which are on record. 1 I 
might dwell on the effects produced by the covering of the marshy 
margins of river shores by sand inundations, as observed on the 
borders of the Baltic, in Holland, Italy, France, Africa, 2 &c, and 
particularly on the well-known case of the Groodwin Sands, in which, 
while, from a similar cause, the usefulness of the land was destroyed, 
the salubrity of the vicinity was firmly established. I might also 
point out those instances, in which the infection of a locality has 
been remedied, by covering the focus of exhalation with earth, as 
was done to Galiopolis, in 1796. 3 

H. McLean, 25; Rush, iv. 154; Ferguson, Recol. 199; Chisholm, i. 294; Ferguson, 
Med.-Ch. Tr. viii. 180, I; Lenrpriere, i. 26; Rochoux, 11; Caillot, 121; Valentin, 
89 ; Gouraud, 65 ; Arnold, 31 ; Furlong, Med.-Ch. Rev. xxv. 289 ; Dickson, Edinb. 
J. xiii. 47 ; Bancroft, 200 ; Berthe, 156 ; Macculloch, 204-6 ; Brown, in Cyc. of Pract. 
Med. iii. 61 ; Cooke, Med. Rec. vii. 457; Pinckard, ii. 485, 6 ; U. Parsons, 204; Irvine, 
Dis. of Sicily, 6 ; R. Jackson, Sketch, ii. 259. 

1 Monfalcon, 43 ; Macculloch, 126, 7; Cycl. of Pract. Med. iii. 61. 

2 Macculloch, 207. 3 Potter on Contagion, 16. 



CHAPTEE IV. 

EXISTENCE AND MOKBID AGEXCT OF MALAKIA, 
CONTINUED. 

The effect of the "washing" of sickly places lead to the same belief — 
In the preceding chapter, attention was called to the salutary effects 
of perfect drainage, as illustrative of the existence and morbid agency 
of a malarial poison. With the same view I may, besides, appeal to 
those instances in which places, heretofore insalubrious, have been 
rendered otherwise, by being thoroughly washed, through the agency 
of a freshet, or an inundation, which carried off all substances sus- 
ceptible of decomposition, and left in their stead a deposit of in- 
nocuous materials — as occurred in New Orleans, after the crevasses 
of May, 1816, and 1849, 1 and more recently in some parts of the 
State of Pennsylvania. In the latter instance, prior to September, 
1850, intermittent fever prevailed to a great extent along the 
course of the Schuylkill, and was found, in many instances, to be 
unmanageable, showing a tendency to a frequent recurrence. But, 
since the flood which took place at the time mentioned, the same 
localities have been remarkably free from it. 2 A flood, the highest 
that ever occurred in the same river, took place on the night of 
the 2d and 3d of September, 1850. "It completely inundated a 
small village, of about thirty houses, in our neighbourhood, besides 
some farm-houses. It filled, of course, all the cellars and wells, and 
it left besides a great deal of filthy rubbish, forming a deposit of 
mud, of several inches in thickness, of a most offensive character. 
The greater part of two weeks must have elapsed before the cellars 
could be cleansed, and the wells be fit for use. Meanwhile, the 
people were living in filth, and without the usual supply of pure 

1 Transactions of the Pennsylvania State Medical Society, ii. 34 ; see also i. 24. 

2 Nicol, Obs. on the Nature of the Climate of Seringapatam, Edinb. J. xi. 290 ; J. 
Johnson on Trop. CI. 101. 



266 PNEUMONIA AND 

water, and the surface of the ground everywhere about them 
covered with the mud above alluded to. Yet, I am not aware that 
this state of things had the least influence in aggravating the fevers 
then prevailing. I asked the wife of a farmer, who had suffered 
as much from the flood as any other person, and in whose family 
intermittent fever prevailed, what effect the flood had had upon the 
disease. Her answer was: "I think we have had less of the ague 
since the flood than before it." 1 In this case, the materials of 
malaria were washed away in some parts, and new innocuous mud 
was left in its place. 

We learn from Yitruvius, that, in the lagunes of Yenice, the air 
was extremely pure, especially around Eavenna, Altino, and Aqui- 
leia, the three principal, and doubtless the most populous points. 
He himself affords us the explanation of this anomaly. At that 
remote period, the marshes and ponds were situate to the north 
and east of those districts, and their bottoms were higher than the 
level of the sea ; owing to which the latter, at every ebbing of the 
tide, carried away all the putrescent materials and filth, and thereby 
cleansed the lagunes. 

In Seringapatam, materials of putrefaction, for about eight 
months of the year, lie all over the banks of water streams and 
other repositories, "until the periodical rains of Malabar begin, 
which, falling in the Ghauts, run down, and fill the Cauvery Eiver. 
The filling of this river is always very sudden, and it comes rushing 
along with great impetuosity; sweeps out all the filth from the 
ditches ; clears away all the impurities, so long stagnant on the 
island; and leaves the place, for a while, tolerably healthy, and 
the air cool and refreshing." 2 

The city of Avignon was inundated on the 30th of October, 
and the 4th of November by a rise of the Ehone. Nine-tenths of 
the city were under water. No fever, however, followed, owing to 
the complete washing which the surface underwent, and the super- 
vention of the cool north winds, which wafted the morbid exhala- 
tiona along the great valley of the Ehone out to sea. 3 

With equal propriety, I may call attention to the results obtained 
in some parts of the Pontine Marshes, as well as in and about the 

' Pennypaaker, of Chester County, Tr. of Perm. St. Med. Soc. i. 69. 
1 .1. Johnson on Trop. CI. 101 ; Nicol, Obs. on the Climates, &c. of Seringapatam, 
Bdinb. .1. xi. 290. 
:) Gonraud, Fifevrea tnterm. IVrnicieuses, 133, 4. 



AUTUMNAL FEVERS. 267 

Eternal City. 1 In former days, that part of Kome on which the 
immense population was crowded, and which is now almost deserted, 
was healthy — comparatively so, at least — while the insalubrious 
sections were the Campus Marti us, the Yelabrum, and other parts 
bordering on the river ; — the site of the modern city. The reverse 
is now the case; for, as we approach the inhabited parts of the pre- 
sent city, through the space separating St. John, of Lateran, from 
the Forum and the Velabrum, we pass over the principal focus of 
the pestiferous exhalations. On the other hand, the surface of the 
Campus Martius, or indeed the whole valley, is free from the tainted 
atmosphere. The very section appropriated to the Jews, the Guetto, 
where the principles of public hygiene are sadly neglected, is, to a 
very great degree, healthy. How has this happened? The Campus 
Martius was purified by Leo X., and the surface, after being divided 
into streets, was soon covered with houses, churches, and other build- 
ings. The population, at the close of the reign of that pontiff, had 
already reached 60,000. The narrow valley, between the Tiber and 
the Pincian Hill, by which we now enter Koine, was transformed 
from a vast marsh into the beautiful Piazza del Popolo ; and other 
portions were, by successive pontiffs, greatly ameliorated. 2 The site 
of the old city, which was not, originally, favourable to health — 
both on account of the peculiar condition of the soil, and its ex- 
posure to the influence of distant sources of miasmal infection, but 
which had been rendered much less hurtful by drains, the erection 
of numerous aqueducts, and other works of kindred character — has 
returned to its pristine state. It has gone to destruction, and is 
now deserted. The houses and monuments by which it was 
covered have disappeared ; the greater number of the aqueducts 
have been destroyed, with the effect of allowing the free escape of 
the water, and the formation of marshes and pools ; the drains have 
been choked up, and the whole surface presents a mass of ruins and 
rubbish. 3 

Much more might be said on this important subject ; but the 
instances mentioned must suffice. They furnish us with both 
proof and counter proof. With the existence of marshes, or 
marshy and partially drained land, we have fever; with the re- 

1 See Carriere, Climat de I'ltalie ; and Tournon, Etudes sur Rome. 

2 Carriere, op. cit. 161. 

3 See Review of Carriere, by the present writer, Am. Journ. of Med. Sci. July, 
1851, p. 1G3. 



268 PNEUMONIA AND 

claiming of that land, or its complete overflow, fever disappears. 
Whenever, as in some cases cited, the surface returns to its pristine 
marshy condition, the unhealthiness of the country returns also. 
Once more the marshes are drained, and, with the improvement of 
the land, we have a cessation of fever. In some instances, the disease 
is found to break out in impure city localities ; the effect is remedied 
by a judicious employment of drains, sewers, and other kindred 
means. Nothing, it appears to me, can be more satisfactory ; be- 
cause no one who has looked at all into this matter, can have 
failed to perceive that, of all diseases which are susceptible of 
assuming an epidemic character, few or none exhibit so clearly 
the close relationship between the existence of certain local agents 
and the effects produced by them, as periodic fevers ; none the 
productive causes of which are more strikingly and undeniably 
under the control of human agency. And when, bearing these cir- 
cumstances in mind, we revert to the fact that the mixture of salt 
and fresh water has been found to increase 1 greatly the unhealthi- 
ness of marshy surfaces — a result foreseen by Vitruvius, 2 pointed 
out more satisfactorily by Lancisi, 3 dwelled upon by Gul. Piso, 4 Sir 
J. Pringle, 5 and Sylvius; 6 noticed more than a century ago in this 
country by Cadwallader Colden, 7 and subsequently by Ludlow, 8 
. and other American writers; and confirmed, beyond dispute, by the 
effects observed at Bender- Abassi, on the banks of the Persian 
Gulf ; 9 at the Valduc ; 10 at Martigues ; in the Luccan Marshes, near 
Viareggio, Motrone, and Montignoso; at Sebgha (Algeria); in South 
America, &c. ; n it will be difficult to resist the conclusion that some 

1 " There dreadful is the air in low places, near the sea-shore, into which the waves 
find entrance by a canal that has either been open during the memory of man, or made 
by human artifice, or produced by a storm ; and into which receptacle also the rains 
wash down the filth from the adjoining knolls and hills." " There are some ponds of 
tlie kind in the territories of Ferrara and Ravenna as well as of Rome, especially near 
Ostea, where the salt-works have been erected. "—Lancisi, op tit. 18. 

2 De Architectura, lib. i. cap. iv. 3 De Nox, Palude Efiiuviis, 16, 18. 

4 Hist. Nat. and Med. lib. i. 9. s Diseases of the Army, Appendix, 870. 

6 Praet. Med. Append. Tract, x. 191. 

7 Recount of the Fever of New York in 1741, 42. Med. and Philos. Register, i. 323. 
New York Med. and Fhys. Jouru. ii. 85. 

9 Chardin, Voyage en Perse; Fodere, Med. Leg. v. 169. 

10 Fodere\ ib. 168. 

" Giordini (Gaetano), Causes de l'lnsalubrite* de l'Air dans le voisinage des marais 
en communication avec la mer. Ann. de Chimie, xxix. 226; Carriere, Climat de 
1 ftalie, 279; Boussingault, Ann. de Chimie, lvii. 150, 151 ; Salva (in Rochoux), 129; 



AUTUMNAL FEVEES. 269 

poison exhales from surfaces where the mixture occurs, and that 
the disease which ensues or prevails more widely there is the effect 
of it, and not simply of heat, moisture, atmospheric vicissitudes, 
or other agencies of the kind. 

The conclusion will appear the more natural when we learn that, 
while such is the effect of the mixture in question, it has been 
found that, in the salinas of France, fevers are limited to the edges 
and immediate vicinities of the rivulets, ditches, and canals sur- 
rounding or running through the salt basins, but containing fresh 
water ; and do not affect the extensive surfaces on which unadulter- 
ated sea-water is introduced for the purpose of evaporation, and 
which, at a certain period of the process, assume the outward cha- 
racters of ordinary marshes; 1 when, besides, we find that, so far 
from these pure salt marshes proving injurious, the physicians of 
Marseilles (Mercandier, Kobert, Peyron, Grirard, &c), to whom the . 
subject was referred for examination, have pointed out, and expe- 
rience has demonstrated, the benefit resulting from the conversion 
of common paludal localities into regular salinas, as may be found 
by referring to the oft-quoted Eeport of Melier, contained in the 
13th vol. of the Memoire of the Academy of Medicine of Paris, p. 655; 
and that, conversely, the change of a salina into a common marsh, 
has been followed by the appearance and wide prevalence of fever,, 
which heretofore had not existed — a change which has caused the 
almost total depopulation and destruction of the once flourishing ' 
cities of Marenne and Brouage, in Prance. 2 Dr. Ludlow, of New 
York, remarks that the results of his observations, made at the 
villages of Salina and Montezuma, New York, where this combi- 
nation takes place is, that it depends entirely on the proportions in 
which the waters are mixed. If the waters of fresh marshes are 
largely combined with salt water, or vice versa, the general healthi- 
ness of the situation will be improved. Dr. Hosack mentions, in 
his lectures, that the marshes of Hoboken, in New Jersey, while 
overflowed by the sea-water, were healthy, intermittent and remit- 

Trail, Outlines of Medical Jurisprudence; McWilliams, 160; Daniel, Med. Gaz. ; Me- 
lier, Mem. de l'Acad. xiii. 684 ; Monfalcon, 69, 70 ; Thouvenelle, Climat de l'ltalie, 
i. 180, 183; iv. 34, 83, 218; Sigaud, du Climat et des Maladies du Bresil, 172; Mori- 
chini, 32. 

1 Melier, op. cit. 635, 636, 684; Jacquot, loc. cit. 21, 25, 47 ; Maillot; Bourdier, in 
same ; Macculloch, 37, 8. 

2 Melier, op. cit. 642, 645; ib. 651, 665. 



270 PNEUMONIA AND 

tent fevers being unknown; but since they have been drained, and 
the ingress of the salt-water has been prevented, these diseases are 
endemic. This was farther proved by the breaking of the dykes 
during their prevalence, when they immediately ceased. 1 When, 
again, we bear in mind that the morbific effects produced in the 
localities mentioned are, sometimes at least, circumscribed, like 
those noticed on shipboard, within very narrow bounds ; that while 
in vessels the area of the infection, which necessarily can never 
be large, is as already stated often limited to one side or one end 
of the under-decks, or to the vicinity of the pumps, where, indeed, 
it usually commences, the disease on land is frequently confined to 
the immediate neighbourhood of a pond, of a mill-dam, of a slug- 
gish stream, of masses of decaying or green timber, or of other 
vegetable or animal substances, separate or combined, in a state of 
decomposition, or of a drain, or cesspool 2 — not seldom to one side 
only of these ; to an overflowed field or bank ; to a few streets of a 
city, to one single street, or even to one side of this ; 3 to a few build- 
ings ; to one solitary house, or side of a house, or room, or corner 
of a room, 4 or the like ; we cannot well see how all these facts — 
the reality of which will not be contested — can be explained on 
the principles set forth by the opponents of malaria. The degree 
of heat and humidity, the extent of the dew-point, the amount of 
atmospheric vicissitudes and other morbid influences to which they 
look for the causes of the disease, can scarcely be supposed to be 
so much greater on one side of a street, in a few buildings, in a 
solitary house, in one room, or corner of a room, than on the other 

1 Op. cit. ii. 85; Hosack's Practice, 175. 

2 Hush, iv. 90; Potter, 16; Caldwell, Dissert. 491, 2; ib. Essay, 69; ib. Fever of 
1805, p. 00 ; Picornel, in Thomas, 8, 22 ; Usher Parsons, Essays, 215 ; ib. Hays's Journ. 
vii. 80 ; ib. Boston Med. Journ. iii. 074, 088 ; Rand, Med. Reposit. ii. 407 ; Valentin, 
Voy. Med. 55, ; Vicq d'Azyr, on City Interments; see Review of this work in Chap- 
man's Journ. vii. 200-8; Audouard, Archives, xii. 312; Tr. of Med. Soc. of State of 
Pennsyl. ii. 51 ; Harris, Charleston Med. Journ. ii. 015; Second Report on Quarantine 

Lond. 1852), 07, 08; Gaultier de Claubry, Mem. de l'Acad. de Med. xiv. 118. 

3 Lancisi, op. cil. 154; Bancroft, 105; Berthe, 74; Baglivi, 158; Rigault de l'lsle 
(in Johnson), 315; Amer. Rev. iv. 290; Faust, Amer. Journ. vi. 53; Trans, of Med. 
Soc. of State of Pennsyl. ii. 93; Macculloch ; Lefoulon, p. 00. note; Pendleton, 
Charleston Journ. vii. 450; Becquerol, sur les Climats, 10. 

1 Lancisi, 154 ; Ferguson, Med.-Chirurg. Trans, viii. 143; Callow in Cycl. ii. 280: 
Wilson, 158, 9; Vatable, 344; Rufz, 28; [mray, Edinb. Journ. lxiv. 355 ; Davy. 
Topog. of Medit. ii. 248; Harris. Charleston Journ. ii. 015: Booth, Life of Arm- 
trong, ii. 721 ; Second Report on Quarantine, 21. 22, 183. 



AUTUMNAL FEVERS. 271 

side of the same street, in adjoining houses, in other rooms of the 
same building, or other corners of the sickly room, to account for 
the difference of results. Everything in this bespeaks the exist- 
ence of a separate morbific agent, penetrating, in combination with 
the atmospheric air to, or generated in the infected spot, and sparing, 
owing to reasons I need not stop to explain, neighbouring or adjoin- 
ing localities. 

Some forms of malarial fevers resemble diseases produced by putrid 
substances introduced into the circulation. — The incorrectness of the 
views of those who refuse to acknowledge the existence and agency 
of a malarial poison, will the more forcibly strike us, when, reverting 
to the preceding circumstances, we bear in mind the great analogy 
existing between the phenomena of some forms of fevers and those 
produced by the introduction of putrid substances in the torrent of 
the circidation, or the forced inhalation of mephitic air, as shown 
by the well-known and oft-mentioned experiments of Gaspard, 
Magendie, 1 Leuret, Hamont, 2 and others ; by the ingestion of va- 
rious mineral and vegetable, and the absorption of some animal, 
poisons 3 — to say nothing of the discovery by Lassaigne, in his 
analysis of putrid meat water, of a stinking volatile oil, the probable 
poisonous agent in the effects obtained by those experimentalists, 
and which can differ but little from the substance dissolved in the 
air of malarious localities. 

Take yellow fever as an example. The late Dr. Harrison, of 
New Orleans, who was perfectly competent to form a correct opinion 
on the subject, speaking of the effects obtained from injecting pu- 
trid meat water into the veins of animals, as shown in the experi- 
ments of Gaspard, already alluded to, says: "No one can, I think, 
fail to be struck with the extraordinary resemblance of those symp- 
toms and post-mortem lesions to those of yellow fever. The charac- 
teristics of the disease, its rapid course, its hemorrhagic tendency, 

1 Journal de Physiologie, ii. 1, and iii. 81-85. 

2 Journal des Progres des Sc. Med. vi. 181. 

3 Fontana, Traite de la Yipere, i. 85 ; Celle, Hygiene des Pays Chauds, 89 ; 
Sauvages, Nosologie, iii. 112, 115; E. Miller, Works, 52, 53; Med. Repos. ii. 412; 
Waring, Yel. Fev. of Savannah, 37, 38; John K. Mitchell, Cryptogamic Origin of 
Fever. To; Hunter, Lhs. of the Army in Jamaica, 150; Dewitt on Stramonium, Med. 
lleposit. ii. 30: Ferguson, Recollections, 204, 5 ; Caillot, Fievre J. 290; Levacher, 
78 ; Chaussier, Consultations de Med. Legale, 40 ; Rochoux, 79 ; Salva, Segundo ano 
del Real Estudio, &c. 142; Lafuente, Observaciones Sobre la Fiebre amarilla, 201. 



272 PNEUMONIA AND 

its peculiar lesions, are all to be met with in these experiments. We 
have black vomit, bloody alvine discharges, redness of conjunctiva, 
extreme tenderness over the abdomen, great and rapid prostration 
of strength, burning thirst, anorexia, &c. — all so characteristic of 
yellow fever. In his other experiments, he speaks of other charac- 
teristic symptoms — suppression of urine, intussusception of the 
intestines, the existence of fetid fuliginous matter in the bowels, 
ecchymosis of the mucous membranes, congestion of the lungs, &c. 
In short, there is hardly any symptom mentioned by authors, as 
occurring in yellow fever, which may not be found in these experi- 
ments ; and it is the same with regard to the post-mortem lesions." 1 
Let it not be supposed that other substances, when injected into the 
veins, will produce similar effects. Gaspard, and after him Magen- 
die, have found that many of them cause death, but none give rise 
to the symptoms or anatomical lesions described above. Those pro- 
duced by ammonia come nearest to them. 

Let us also bear in mind that dead animal matter is found to 
run faster into putrefaction, in situations where, from the prevalence 
of fever, marshy exhalations may be supposed to abound ; that 
beer, wine, and other fermentable fluids, if kept there on the 
ground, spoil sooner than in healthy localities; 2 that the active 
operation of such exhalations on sores and wounds is often evinced 
during life; that substances fabricated of silk, wool, cotton, and 
flax, very rapidly undergo decay when exposed to the atmosphere 
of such situations — silk and woollen becoming putrid, and cotton 
and linen assuming a dingy or yellow hue, and afterwards losing 
their cohesion; and that these effects, which in Italy, France, and 
other countries are generally recognized as indicative of the insalu- 
brity of particular places and seasons, though rapid and complete 
in proportion to the moisture and warmth of the air, exhibit them- 
selves to the fullest extent when these conditions are combined 
with sources of concentrated malarial exhalations. 

When, besides, we recollect that the absorption of softened tu- 
bercular matter, in small proportion, and in the early stage of its 
formation, produces an intermittent form of fever, of quotidian 
type, and recurring in the evening; that, with the progress of the 
Battening of this matter and of its absorption, the type of the fever 

1 Speculations on the Cause of the Yellow Fever, N. 0. J. iii. 570. 
1 Barton, on Hong-Kong Fever, Dublin J. (N. S.) xii. 845. 



AUTUMNAL FEVERS. 273 

changes, becoming first remittent, and, finally, continued ; when we 
recollect that the fever attendant on the absorption of pus formed 
in the parenchyma of the liver often assumes the tertian type, and 
that intermittent febrile paroxyms of great regularity have resulted 
from such absorption - 1 when, finally, we bear in mind the changes 
which take place in the system of those who recover from yellow 
or other malarial fevers, through the unaided efforts of nature ; the 
coincidence of the sudden and successive disappearance of the 
symptoms with the appearance of phenomena of a critical character 
— dark discharges from the bowels, sbuadant sweats, and a copious 
flow of flocculent and sedimentous urine — so like what is known to 
attend the expulsion or elimination of some poisonous substance, 
it is impossible to avoid the conclusion that fevers, when they make 
their appearance in the localities mentioned, are the offspring, not of 
a cause of a general character or of physical influences, consisting of 
some particular modification in the ordinary and sensible qualities 
— therm ometrical, hygrometrical, electrical, &c, of the atmosphere; 
since these operate in equal degree all around, without, however, 
producing everywhere the morbific effects in question; but of some- 
thing exhaled from the soil, or from some of the various sources of 
decomposition adverted to. In other words, we must infer that 
fevers arise from the impress of a species of morbid material poison, 
which finds admission in the blood, and occasions peculiar changes 
in certain of the constituents of that fluid — conferring subsequent 
immunity in many cases, like other causes of a kindred nature, 
though in a less degree, and with less certainty ; possessing, to 
some extent, other characteristic properties of true morbid poisons, 
but differing from them in not being the product of operations 
taking place in the living system; in its not being possessed of the 
power of reproducing or multiplying itself in the body ; in its not 
converting any of the elements of the blood into its own similitude, 
and in its effect not being capable of propagation from one person 
to another. 2 

The geological formation of sickly localities, and the plants growing 
therein, &c, lead to a belief in the malarial doctrine. — The conclusion 
will appear still more natural, when we take the following facts 



1 Boudin, 128, 129 ; Griffin, Lond. Med. Gaz. 

2 See Simon's Lect. on General Pathology, 198, Am. ed. 



18 



274 • PNEUMONIA AND 

into consideration: Malaria is more rife in localities characterized 
by particular geological formations. In both the West and East 
Indies, places where the mangrove and mancilina grow luxuriantly, 
the most unhealthy are those in which the roots of those plants are 
only occasionally under water. In general, in tropical latitudes, 
the existence of a large quantity of astringent plants— the bark of 
which contains a large portion of animal matter, combined with 
tannin— is connected with the development of fever. 1 Mr. Boudin 
informs us, in his Treatise on Periodic Fever, that, from some experi- 
ments made by himself, he is inclined to the opinion that certain 
plants, more than others, have the power of giving rise, by their 
decomposition, to the evolvement of febrific exhalations. Such are 
some of the algce, as, for example, the chara vulgaris. He attributes 
the same febrific faculty to the rizophore and the calamus (p. 59). In 
some parts of France (the Department of Ain — see the statistics of 
that Department, p. 206), a similar agency is attributed to the An- 
thoxentum odoratum. 

Cause more effective near the surface of the earth than at a distance. — 
The cause, though sometimes wafted to elevated spots, generally 
manifests a tendency to remain near the surface of the soil, attacking 
more generally, and with greater malignancy, individuals occupying 
the lower floors of houses. 2 In Italy, and along the shores of the 
Mediterranean, as well as in the West Indies, the ground floors are 
never occupied by those who can avoid them ; and, in some parts 
of the latter country, the houses are built upon pillars, by way of 
avoiding the poison. When the Corsican peasants are obliged, in 
the autumn, to leave their hill-towns, for the purpose of working 
in the fields below, they never fail, if possible, to return home in 
the evening. When, however, the distance is too great, they con- 
struct temporary cabins on the tops of the trees, to which they 
carefully nscend for the night. 3 

Much of this may arise from the refrigeration produced by rip- 
ward radiation of heat, which, as is well known, exercises a marked 

1 Humboldt, 763-771; ih. Personal Nar. iii. 191, 872. 

2 Smith, IVv. of Gibraltar, Edinb. J. xxxv. 35; J. Hunter, 306; Cyel. Tract. Med. 
ii. 280; Ralph. Trans, of Edinb. Med.-Chir. Soc. ii. 57, 59; ib. Rep. in Ferguson, 
Mi d.-Chir. Tr. viii. 170; Bancroft, Seq. 448; Blair (notes), 30; Caldwell on Malaria, 
180; S< oond Rep. on Quar. 60. 

* Jacquot, 9. 



AUTUMNAL FEVEES. 275 

influence as an exciting cause of disease. 1 But this radiation, how- 
ever powerful in the latter capacity, and however likely to arouse 
into action the dormant efficient cause, cannot of itself give rise 
to any of the various forms of autumnal fevers, seeing that it exer- 
cises the influence under consideration only in localities the infec- 
tious character of which is well ascertained, and where febrile 
attacks take place without its agency. Add to this that diseases 
justly referable to its sole agency belong to a different class. 

Cause of fevers destroyed or mitigated by sanative measures. — The 
morbid effect of the cause is destroyed or mitigated, and its action 
neutralized by disinfectants and antiseptics, which operate in the 
same way on contagious poisons, and arrest the process of decompo- 
sition in animal and vegetable substances. The beneficial effects of 
these agents, in all the cases in question, indicate a similarity of 
nature in the morbid causes upon which they exercise their neutral- 
izing and destroying influence. Cold, a most powerful disinfectant 
and antiseptic, which prevents decomposition for an indefinite, if not 
infinite, period, arrests, as we have seen, the prevalence of fever. 
Of the disinfecting or deodorizing power of fire or heat, much has 
been said by philosophers and physicians in olden times ; indeed, if 
the claims of any hygienic means to our respect could be enhanced 
by its antiquity, few would be more entitled to it than the one in 
question. It was recorded long before the days of Pliny, who 
speaks of it as of a thing well known : " There exists in the very 
fires a remedial power against pestilence occasioned by obscuration 
of the sun by clouds, and by an excess of moisture. Fire, by its 
fumigation, certainly assists in many ways. Empedocles and Hip- 
pocrates have demonstrated this amply." 2 Poets, too, recognized 
the benefits derived from that agency. " Or all noxious principles," 
Yirgil says, " may be dried out of them by fire, and useless moist- 
ure driven out : — 

1 Sive illis omtie per igneiit, 
Excoquitur vitium, atque excedat inutilis humor.' " 

The reader will doubtless recollect that it is reported of the father 
of medicine, that he changed the morbific state of the atmosphere 

1 See on this subject an excellent Report in the Gth vol. of Trans, of Am. Med. 
Assoc. 

2 Cap. 27, lib. 36. 



276 PNEUMONIA AND 

at Athens, during the plague described by Thucydides, by kindling 
large fires. 1 The same is related of Acron of Agrigentum. 2 At a 
less remote period, the city of Kome furnishes a striking example 
of the benefit which was supposed to arise from the same practice. 
" Rome," as Lancisi remarks, " an unwholesome region may, thanks 
to her furnaces, be inhabited with safety." Monfalcon informs us 
that, when the French troops occupied the Mantuan, during the 
early Italian campaigns of Bonaparte, they were forced to encamp 
on the marshy surfaces which abound in that province, and in con- 
sequence exposed to malarial fevers. Bonaparte succeeded in pre- 
serving the health of his men, by ordering them to keep, day and 
night, near large fires, kindled for that purpose. 3 

Sir Gilbert Blane speaks in the highest terms of heat as a puri- 
fying agent on board of ships, and states that nothing served to 
contribute so much to disinfect the filthy French ships captured by 
Admiral Rodney in the famous battle of 1782, and sweeten. the air 
in them, as burning fires in the hold. 4 And we all know the ad- 
vantage resulting, in all malarious localities, from warming and 
drying the houses, especially early in the morning, and at the 
approach of night. 

Chlorine, and other fumigations, destroy ammonia and organic 
bodies with more or less facility ; and there are not wanting facts 
to show that they exercise a salutary influence in mitigating or 
arresting the progress of fever. 5 The same may be said of chloride 
of lime, whose efficacy, though doubted by some observers, 6 is 
highly thought of by reliable professional authorities in this and 
other countries; 7 of chloride of zinc, which is highly extolled by 
competent judges; 8 of smoke, which has been successfully employed 

1 Galen, Therap. ad Pison; Aetius, v. 94. 

2 Plutarch, De Iside et Osiride, see Adams's Trans, of Paulus JEgineta, i. 274 ; 
ib. Tr. of Hippocrates, i. 12. 

3 Traite des Marais, 201. 

* Diseases of Seamen, 117, 287; see also Blane's Dissertation, i. 220; Folchi, N. 
A. Med. and Surg. Journ. vii. 252 ; J. Clark, 67. 

5 Savaresi, 451 ; Dariste, 227 ; Bally, 591 ; Valentin, 233 ; Arnold, 18; Robert, 574 ; 
Townscnd, 223; Cullom, 365; Guyton Morveaux, Carmichael Smith, Playfair, Gra- 
ham. Hoffman, Cooper, in Sec. Rept. of London Commissioners, 1848, p. 32, &c. 

6 Bowie, in same work, 83. 

7 Johnson, Some Account of the Origin and Prevalence of Yellow Fever in Charles- 
I fh&rleston Journ. iv. 164 ; Southern Agriculturist, iv. 250, 417, as quoted by Dr. 

Johnson. 

■ T.ryson, 225. 



AUTUMNAL FEVERS. 277 

in Germany, France, and elsewhere, on land and on shipboard; 1 
as well as of the sprinkling of lime, 2 and of ozone, the most power- 
ful of disinfectants. 3 

Dr. Stokes relates somewhere the instance of a district of Corn- 
wall, where paludal fevers prevailed extensively, and have disap- 
peared since the establishment of a copper foundry. It is known 
that during the fusion of copper, an escape of arsenical particles 
takes place. In this respect malarial diseases approximate to those 
produced by animal poisons. M. Bousquet has found that the 

1 Zimmerman, de FExperience, notes by the translator. Bonnet, Essai sur la Puri- 
fication de 1' Air,, 17 ; see also Hoffman and Van Swieten. Galeron, Mem. de la Soc. 
Roy. de Med. iii. 44 ; Lincl on Seamen, 74. 

* Forbes's Review, July, 1844, p. 196. 

s This substance, which at one time was supposed to constitute the efficient cause 
of epidemic diseases, because it is sometimes found in the atmosphere during the 
prevalence of these, may now, if the experiments of Dr. Schcebein 1 are to be relied 
upon — and, so far, no doubts have been expressed on the subject — be considered as 
the most powerful disinfectant, and the great purifier of the atmosphere. It destroys, 
quietly and effectually, the miasma disengaged from putrid flesh ; and there is every 
reason to believe that it acts as efficiently in regard to the cause of fever, as to 
atmospheric poisons, artificially produced; whilst its effects in respect to these and 
its virtues as a destroyer of the cause in question, lend a strong support to the opinion 
which ascribes fever to the existence, in the air, of peculiar poisonous exhalations. 
Ozone is abundantly found during thunderstorms, and we know that these purify the 
atmosphere, mitigating or arresting the spread of epidemic fever. If it is diminished 
in volume, by the presence of impurities artificially produced, and whose presence in 
the atmosphere cannot be doubted, it is, in like manner, found in less quantity in hot 
seasons and fever regions, where malaria may be supposed to exist in greater abund- 
ance ; and if, in the former case, the diminution in question is produced by the action 
of the disinfectant, in neutralizing or destroying the existing impurity, we cannot 
greatly err in referring the diminution, in the latter case, to a like action of that sub- 
stance on a kindred poison, and its consequent consumption. Ozone, on the other 
hand, exists in greater abundance in winter ; and, as this is precisely the season at 
which miasmal fevers do not prevail, and when the atmosphere is in the greatest state 
of purity, we are justifiable in the conclusion that its accumulation, at that period, 
arises from a less demand of it for the decomposition of oxidable miasmatic matter or 
poison. Again, it has been found that the higher strata s of the atmosphere are more 
ozoniferous than the lower ones, an effect easily accounted for by the circumstance 
that those strata contain a less quantity of that oxidable miasmatic matter than those 
portions of the atmosphere which are nearer the surface of the earth, and that hence 
a smaller quantity of the disinfectant substance is consumed. In a word, ozone acts 
like chlorine, by destroying impurities existing in the atmosphere ; and, if it purifies 
the air of infected localities, and destroys the cause of fever, it can only do so by 
destroying or neutralizing a kindred impurity, or poisonous exhalation, floating in the 
atmosphere of such localities. 



l Med.-Chir. Trans, xxxiv. 212. 



978 PNEUMONIA AND 

chlorides produce an important change in the vaccine matter, and, 
indeed, annihilate its specific property, when the mixture is pro- 
perly made and somewhat prolonged. 1 The syphilitic virus, ac- 
cording to Kicord, unless not very much diluted, is not affected by 
mixture with saliva, urine, vaginal mucus, muco-purulent matter of 
the urethra or vagina, fecal matter, sweat, or sperm ; but is destroyed 
by an alkali, or an acid, as the sulphuric, nitric, chlorhydric, acetic, 
&c. ; by chlorides, potash, soda, ammonia, wine, alcohol, concentrated 
decoction of tan. 2 Vaccine matter is destroyed by great heat, 3 and 
by frost. 4 

Cause arrested by trees, &c. — The extension or diffusion of the 
cause is arrested by trees, walls, hills, rows of buildings, canvas, and 
other such obstacles. 5 Lancisi cites a number of facts showing the 
advantages of belts of trees in protecting against the effects of 
malaria, and the danger resulting from their removal. He calls 
attention to the fact that, in former days, there existed on the south 
side of Home a thick forest. It extended from Frascati and Albano 
to the Tiber, and protected the southern portion of the city, and the 
neighbouring district, from the baneful influence of the effluvia of 
the Pontine Marshes. This rampart has since been removed, and 
the country has become proverbial for its unhealthiness. 

Lancisi did not for a moment doubt the utility of these belts, 
and expresses the opinion that the consecration by the ancients of 
woods and groves had no other motive than guarding, through 
their means, against the diffusion of the febriferous poison. 6 In this, 
he was probably right. Among the Eomans, the advantage of 
such barriers had long been recognized. Trees were planted in 
rows and in masses, to guard against the diffusion of malaria. The 
practice was enforced by law, and recorded on the Roman tablets. 
This law, which was reported by Cicero — "Lucos in. agris habinto" — ■ 

1 Nouveaux Traite de la Vaccine, 220. 

2 Tr. Pr.it. des Malad. Vener, 178; Lettrcs J. 86. 

:1 Anglada, i. 218. 4 Bulletin, ii. 1051. 

5 Rigaull <le L'Isle, in Johnson, Trop. CI. 807, 314, 31G, 317; Mitchell (J. K.J, 26, 
1"": Maconlloch, 116,252,8; Williams, Morbid Poisons, ii. 448, 453; Johnson, 
Change of Air. 1 18; Evans, 15; Caldwell on Malaria, 185; Tonrnon, loc. at. i. 209; 
Watson's Practice, 158; Bonnet, Fiev. [nterm. 811 ; Drake, i. 727; Monfalcon, 93, 94, 
160; Inneslej on Diseases of Indin ; Wilson Philip, on Fevers, i. 79; Hosack, Trac- 
t'"'<'. 17 1 ; Dundas, Sketches of Brazil, 246; De Renzi Miasmi Paludosi, 30. 

b Op. tit. 80, &o. 



AUTUMNAL FEVEKS. 279 

had reference evidently much more to the advantage in question, 
than to the purposes for which trees are usually planted. In order 
to insure their safety, such collections of trees were placed under 
the protection of some divinity, or under the responsibility of the 
Roman consuls. 

" Sive sacro pavi, sedive sub arbori sacra," says Ovid. 

" Si canimus sylvas, sylvse sint consula dignae," according to 
Suetonius. 

Bapt. Donus, in his work on the means of insuring salubrity to 
the soil of the Roman States, recommends the planting of pine and 
other trees between Rome and the Pontine Marshes, to intercept 
the miasmata wafted from these by the south-west winds. 1 At 
Velletri, as also at Campo Salino, the destruction of belts of woods 
was followed by the prevalence of fever. 

The following fact, published by Dr. Lewis in his medical history 
of Alabama, on the authority of Dr. Wooten, at present, I think, 
Professor in the Medical School of Memphis, is interesting and ap- 
posite : " Mr. P. E. had negro-quarters situated on the first prairie 
elevation above the low grounds of a small creek, the fourth of a 
mile from the houses. The belt of low ground frequently over- 
flowed, causing water to remain in holes over its entire breadth, on 
the subsidence of the stream, but it was well shaded by a dense 
foliage, the plantation lying on the prairie in the rear of the cabins. 
In the winters of 1842 and 1843, the trees between the houses and 
creek were cleared away ; and up to that time, some eight or ten 
years, the negroes living in this quarter had enjoyed uninter- 
rupted health, a case of fever scarcely ever occurring. During the 
summer of 18-13, the first after the forest had been cleared away, 
fever prevailed among the negroes with great violence, continuing 
until frost. The negro -quarters were afterwards removed to the 
opposite side of the creek, about the same distance from it, but 
with an intervening growth of timber, and no fever has occurred 
on the place since." 2 

" Whole families," says Mr. Bartlett, " have resided near the Pon- 
tine Marshes, and, by the intervention of shrubs and trees, have 
escaped for years the noxious effects of the mephitic vapours which 
those putrid waters engender." 3 Dr. Hosack states that a family in 

1 De Restituencla Salubritate Agri Romani, 1G67. 

2 New Orleans Journal, iv. 4. 3 Thompson's Annals. 



280 PNEUMONIA AND 

New Jersey was attacked with fever in consequence of cutting down 
a wood that separated them from a morass in the neighbourhood. 
Before that operation, they had been healthy. 3 " Army physicians, 
therefore, recommend," says Dr. Wilson Philip, " having a wood, if 
possible, between marshy grounds and an encampment." 2 Eigault de 
Lisle calls attention to the fact that, upon Mount Argental, above 
the village of St. Stephano, there is a convent, which has lost all 
the reputation for salubrity which it once enjoyed, since the lofty 
trees, by which it was surrounded, have been cut down. I have 
been informed, he adds, by persons worthy of credit, that, in con- 
sequence of the felling of the wood before Asterna, near the Pontine 
Marshes, Yeletri was visited for three successive years by diseases 
which made much greater havoc than usual throughout the whole 
country, and penetrated to many places which they had not pre- 
viously been accustomed to reach. Eigault de Lisle cites other 
cases, and refers to Yolney, who states that Beyroot, formerly very 
unhealthy, has ceased to be so since the Emir Fakr-el-din planted 
a wood of fir-trees, which still exists, a league below the town. 

By Pliny and others, among the ancients, it was supposed that 
trees absorb the exhalations extricated from insalubrious places, 
and that the beneficial effects obtained from woods are to be 
accounted for in this way much more than by the obstacles they 
offer to the diffusion of those exhalations. This opinion has, to 
a certain extent, received the sanction of Thouvenelle, Copland, 
and other modern writers ; and its correctness is rendered probable 
by the results of certain experiments made long ago, and repeated 
more recently to ascertain the fact. " Plants," says Julia de Fon- 
tenelle, " which Priestley had inclosed in glass jars filled with viti- 
ated air, continued to thrive, and, at the end of a few days, this air 
had become as pure as that of the surrounding atmosphere." 3 A 
more recent writer, Dr. Lewis, of Mobile, reverting to the subject, 
remarks : " It is the generally received opinion that living vegetation 
protects the human system from the deleterious effects of malaria; 
and, reasoning by analogy, it would appear that experiments made 
by scientific men have satisfactorily explained the mutual depend- 
ence of the animal kingdoms on each other for support. It has 
been ascertained that if air, rendered pernicious by respiration, be 

' P»«t»M Of Medicine, 174. 2 A Treatise on Feb Dis { 79 Am ed> 

3 Op. cit. 139. 



AUTUMNAL FEVERS. 281 

confined in a bottle, into which some green plant has been intro- 
duced, and exposed to the. action of the sun, the carbonic acid will 
be absorbed, and the air restored to its original condition. The 
putrefaction of animal matter, and the decomposition of vegetable 
substances would cause a sufficiency of carbonic acid vapour, when 
united with atmospheric air, to destroy every living being, were it 
not for this wise provision of nature. This gas, which is poisonous 
to the human as well as animal species, is a source of nutriment 
to every variety of plant ; and thus, it would appear, exercises a 
benign influence in protecting men from the deleterious effects 
of poisonous vapours." 1 And if the effect is obtained so far as 
regards one species of poisonous vapour ; it may be equally so in 
reference to that giving rise to fever. 

Facts, indeed, are not wanting to show that aquatic plants, as 
well as certain vegetable substances, growing in damp and swampy 
or marshy soils, possess the property of disinfecting them — a virtue 
which, as is well known, Dr. Cartwright ascribes more particularly 
to the Jussiena Grandifolia, an exclusively aquatic plant found in 
great abundance in some parts of the Southern States, and espe- 
cially in some regions of Louisiana, which, though presenting many 
of the usual characteristics of malarial surfaces, are exempt from 
fever. 2 

A distinguished natural philosopher, Changeux, inferred from 
the results of his experiments, that the action of trees in the pro- 
duction of the effect under consideration is twofold. " Plants," he 
says, " whether odoriferous or inodoriferous, give issue to emana- 
tions, which, when mixed with poisonous vapours exhaling from 
marshy or damp soils, neutralize their pernicious influence. But 
the former exercise a greater effect through means of the neutral- 
izing process than by the power of absorption just mentioned; 
their emanations mixing with the air we breathe, and correcting 
its deleterious properties by virtue of the particular qualities 
with which they are endowed. The second class — the inodorife- 
rous, on the other hand, act more evidently through means of their 
power of absorption than of the neutralizing property of their ema- 
nation, and remove from the air the vapours by which it is con- 
taminated." 3 

1 Med. Hist, of Alabama, New Orleans Journ. iv. 4, 5. 

2 Western Journal of Medicine and Surgery, i. 428, &c. 

3 Journal de Physique, vi. 211. 



282 PNEUMONIA AND 

By not a few able observers and expert experimentalists, the .dis- 
infection is ascribed, not to the absorption by trees and other vege- 
1 3 substances of the gaseous poison floating in the atmosphere 
of malarial localities, but to the purification of such an atmosphere 
through means of the large supply of oxygen obtained from living 
plants, and the neutralizing agency of that gas on the mephitic 
particles it meets with in insalubrious places. 1 As to the manner 
in which the oxygen thus produced destroys or prevents the elabo- 
ration of the malarial poison, some difference of opinion exists. 
M. Carrier e, in his excellent work on the climate of Italy, adopts 
the views of Chevreul and Fontana, in relation to the formation of 
the febrific poison through means of the action of organic matter on 
the sulphates contained in the earth or in water with the aid of the 
oxygen derived from the former. • According to this writer, the 
leaves of plants and of trees, as well as the green substances that 
cover the soil, are all inexhaustible sources of oxygen, which 
is so important to sustain life and preserve health. This fluid, 
thus furnished, offers an obstacle to the action of organic mat- 
ter. If the latter acts chemically on the sulphates, the other, in its 
turn, reacts on those compounds, and, from the double antagonistic 
action thus produced, a state of equilibrium, advantageous to the 
purity of the air and the salubrity of the country, is re-established. 
" Hence, to cover the fields, the edges of marshes, and the whole 
extent of the soil with an abundant vegetation, is equal to placing 
on the surface of unhealthy regions a reparative apparatus of the 
greatest power." M Trees, therefore, must have a large share in the 
amelioration of the country, in consequence of the quantity of 
leaves they furnish." 2 

By others, again, it has been remarked, doubtless with much 
truth, that malaria is collected by plants, particularly those of a 
dense and entangling foliage, so as to be disengaged on cutting 
thern down or rooting them up, thus exciting fever in the labourers 
who might otherwise have escaped, as proved by the circumstance 
that in all those situations while the workmen are in the erect 
posture, and engaged at their work, they escape the fever, but are 
attaeked if they sit, and, more particularly, if they lie down on the 
md— and that whether they sleep or not. 3 Whether these views 

1 Senebier, Physiologie Vggetale, iii. 184, &c. 

■ Le Climat de I'ltalie, 828. 3 Edin. Rey. xxxvi. 546. 



AUTUMNAL FEVERS. 283 

be correct or otherwise; or whether the effect is generally due to 
the mechanical obstruction trees afford to the transit of malaria 
from its source, while the exemption of individuals who keep the 
erect posture, and their liability when they sit or lie on the ground, 
are to be explained by a difference in the amount of terrestrial radia- 
tion, or by the greater quantity of contaminated air they breathe, I 
need not stop to inquire, and dismiss the subject with the simple 
remark that, the same results being obtained from the interception 
occasioned by walls, houses, hills, &c., we are justified in inferring 
that trees, though they" may perhaps act as absorbents, act also, and 
principally, in the mechanical way mentioned. Be this as it may, 
Dr. Ferguson, calling attention to the attraction of marsh poison for, 
or rather its adherence to, lofty umbrageous trees, says that "this is 
so much the case that it can with difficulty be separated from them ; 
and that in the territory of Guiana, particularly, where these trees 
abound, it is wonderful to see how near to leeward of the most pes- 
tiferous marshes the settlers, provided they have this security, will 
venture — and that with comparative impunity — to place their habi- 
tations. The town of New Amsterdam, Berbice, situated within 
musket-shot to leeward of a swamp extremely offensive at a certain 
stage of dryness, owes, evidently, its ordinary exemption from fever 
to this cause." "A still better instance of the same, and with the 
same results, may be seen at Paramaribo, the capital of Surinam, 
where the trade-wind, that regularly ventilates the town, and ren- 
ders it habitable, blows over a swamp within a mile of the town, 
which, fortunately for the inhabitants, is covered with the same 
description of trees." 1 But whatever be the way in which these 
operate in promoting the salubrity of malarial localities, the effect 
tends to show that the benefit obtained is due to the destruction of 
a poisonous agent floating in the air, or to the obstacle it encounters 
in its passage with the atmosphere from one place to another. 

Fever arrestedhy removing sources of infection. — The progress of fever 
has been arrested by the clearing and washing of gutters, streets, 
sinks, and sewers — by the removal of other sources of effluvia; 
while in ships, as we have already seen, epidemic prevalences of 
yellow fever have been arrested, and health restored, by kindred 
means. 

1 Marsh Poison, in yoI. of Notes and Recol. 195, 6. Sec also Williams on Morbid 
Poisons, ii. 448. 



284 PNEUMONIA AND 

Fever sometimes connected with the existence of certain fogs or mists. — 
Instances are on record in which the surfaces of highly insalubrious 
marshy localities have been found at particular hours of the day, 
covered over with a heavy foggy cloud of a peculiar character, and 
which carries infection 1 wherever it is propelled; while ordinary 
fogs in the vicinity, or elsewhere, are perfectly innocuous, so far as 
relates to the production of autumnal or periodic fevers. Such 
was the case, for example, in Wilmington, in 1798. Such also has 
been found over the town of Huaura, in South America, where 
marshes are extensive. There malaria is stated to have been found 
distinctly separate from the atmosphere, lying at an average of two 
or two and a half feet above the marsh, and distinguished by a 
peculiar kind of opalization, which, on certain changes of light, 
exhibited a yellowish tint. 2 

Allusion has already been made to the smokes of the African 
coast. These very frequently, if not generally, carry with them 
the seeds or cause of fever, and, while doing so, impress the system 
in a different way from ordinary fogs. In a case mentioned by 
Sir J. Pringle on the authority of Mr. Lauder, surgeon of a horse 
regiment, the meadows and marshes on each side of the road which 
the troops had to pass over on their way to forage, were covered, 
at an early hour, with a thick fog of an offensive smell, which he 
considered as the chief cause of the sickness which affected the 
men, as few who were exposed to its impression escaped an attack. 3 
Pringle also states that, in 1748, the nocturnal fogs near the inun- 
dations, were thick and fetid. 4 Dr. J. Johnson states that when, 
at Batavia, the land-breeze came off from the low, swampy grounds 
about the place, early in the mornings, it brought with it a thick 
mist, accompanied by a very fetid smell ; all of which would gra- 
dually go off as the sun rose, and the sea-breezes set in. During 
the prevalence of this fetid mist, ; many people complained of slight 
indisposition in the head and stomach, which, likewise, went off as 
the sun rose. 5 We know, however, that all do not get well who 
breathe that mist, for the great prevalence of fever about Batavia 
is proverbial. 

The following case occurred in St. Lucia: Two men, after finish- 



1 Van gh an' s Med. Rep. iii. 36. 






- Vuu Tsclmdi's Travels ia Peru. 

1 P. 178. 

' Trop. Climates, 127. 


See Edinb. Journ. Lxix. 489. 
4 P. G3. 


Watson, 451. 



AUTUMNAL FEVERS. 285 

ing their clay's work, before returning home, were occupied in haul- 
ing their canoe high upon the beach, close to the most dangerous 
part of a large swamp, when they perceived, immediately to wind- 
ward, a small cloud of vapour gradually approaching them. In a 
short time they were enveloped in it. One of them fell clown, ap- 
parently in a state of asphyxia, and the other was so affected as to 
be unable to render him any assistance. The latter soon recovered, 
while the other, after coming to sufficiently to be led home, was seized 
in the night with an intense ague, during which the surface of the 
body was cold, the countenance expressed great anxiety, and the 
pulse was small and scarcely perceptible. The patient was insensible 
to surrounding objects, and in a state of coma, only interrupted by 
severe convulsions. This cold stage continued about three hours, 
and was followed by reaction attended with coma alternating with 
delirium, vomiting of mucosities, and pain in the stomach aggravated 
by pressure at the epigastrium. A remission followed, which, in its 
turn, was succeeded by another paroxysm equal in violence to the 
last, except that the cold stage was scarcely perceptible. Death 
occurred about forty hours from the period of exposure. On dis- 
section, the blood was found fluid, and a small quantity of turbid 
serum was effused between the arachnoid and pia mater; the lungs 
were somewhat engorged, and the stomach was intensely inflamed, 
containing two or three ounces of blood in its cavity. The other 
man stated that the vapour had no perceptible smell; that it was 
warm and moist, like steam, stopped the respiration for a moment, 
and produced a sense of faintness and trembling of the whole body. 1 



The stagnant water of marshes injurious to health. — Stagnant water, 
particularly that contained in marshes and swamps, cannot support 
animal life, and furnishes no element for the sustenance of fish. 
The discharge of such water into ponds or lakes has not unfre- 
quently given rise to the sudden destruction of those animals con- 
tained therein. 2 To produce such an effect, it must contain in solu- 
tion some poisonous matter ; and if so, it is not unreasonable to 
suppose that this poison is taken up with the vapour absorbed in 
the atmosphere, and that it affects those who are exposed to the 
influence of the latter. 



1 Evans, R., Clinical Treatise on the Epidemic Fevers of the West Indies, 21. 

2 Monfalcon, 44. 



286 PNEUMONIA AND 

Nor is it unreasonable to admit that the water of paludal sur- 
f aces __ f marshes, particularly— may, when used as drink, give rise 
to diseases similar to those resulting usually from the action. of 
the exhalations evolved from them. Centuries ago, Hippocrates, 
in his masterly work on Airs, Waters, and Places, while treating in 
a special and interesting section of the nature and morbid effects of 
such water, attributes to its use the enlarged spleen so frequently 
noticed among the inhabitants of marshy districts— a pathological 
condition which we now view as one of the effects of malarial poi- 
soning; and though there can be no doubt that this deleterious effect 
is usually the result of the absorption of the exhalation in a gaseous 
form through the agency of the respiratory process, there are facts 
to show that it may sometimes arise from the internal use of water 
impregnated with the poison. M. Boudin, in support of this opi- 
nion relates the following case : A Sardinian vessel, the Argo, left 
Bone (Algeria) in July, 1834, with 120 soldiers in good health. 
During the passage to the lazaretto of Marseilles, thirteen of these 
soldiers died, and at the arrival of the vessel ninety-eight had the 
fevers, of all forms and types. While such was the case among 
the soldiers, the crew remained in health. On inquiry, it was found 
that this result arose from the fact that the crew had made use of 
pure water they had procured for that purpose, while the soldiers 
had been obliged to content themselves with water derived from a 
marshy locality situate near Bone. The few soldiers who escaped, 
were those who had purchased water from the Sardinian sailors. 1 
It must be added that two other vessels which sailed at the same 
time from Bone, filled, like the Argo, with soldiers, but in which 
pure water was used by these as well as by the crew, arrived at 
Marseilles in good health. 2 

The following fact, related by Dr. Drake, on the authority of Dr. 
Trowbridge, deserves, on more accounts than one, to be recorded. 
In the neighbourhood of Buffalo, for three (but not successive) 
autumns, a local epidemic fever occurred among about twenty fami- 
lies, who drank, or otherwise used water, from the same spring. It 
burst out beneath a ledge of limestone, about twenty -five feet below 
tbe summit, beyond which, at the distance of a mile, there was a 
• ■ of woodland with a pond, which Dr. Trowbridge supposed to 
be the source of the spring; for, after rains, its waters became tur- 

' Boudin, Peyera Enterm. GG, G7. , 2 Ibt olograph. M£d. 55. 



AUTUMNAL FEVEES. 287 

bid. The autumns in which the fever prevailed were unusually 
dry. In its symptoms and violence, the disease might have passed 
for yellow fever. Nine or ten persons died. The surrounding 
neighbourhood remained healthy. The spring was at length aban- 
doned, and the fever did not return. Dr. Drake remarks that this 
seems to show that the material cause of autumnal fever may be 
absorbed by water, and thus produce its characteristic effects. 1 

A paludal atmosphere enfeebles health. — The feeble health entailed by 
a long residence in fenny and fever regions, results often from a 
frequent repetition of febrile attacks; as, frequently, it manifests 
itself without the occurrence of open fever — intermittent, remittent, 
or continuous. It depends on pathological conditions of a special 
kind, characterized by phenomena equally peculiar, and indicates 
the agency of a morbific cause other than a mere modification in the 
relative proportion' of the natural constituents of the atmosphere, 
or in the thermometrical or hygrometrical state of the latter. En- 
largement of the abdomen, and engorgement of its viscera, and 
a morbid state of the blood, consisting in the simultaneous dimi- 
nution in the proportion of the globules, of the albumen of the 
serum, and sometimes of the fibrin, attended with a bloated, pale, 
and sallow countenance, a flabbiness of the flesh, an ©edematous 
condition of the cellular tissue, and, in some localties, a disposition 
to ulcers and to gangrenous sores, are frequently, if not always 
encountered in such regions, and have been noted by high profes- 
sional authorities. 2 The evil which this poison inflicts on man 
is painful to tell, amounting in time to a total humiliating degene- 
racy of the race. The late Professor Caldwell remarks, in one of 
his works, 3 that those who would witness that result, in its highest 
degree, must visit some of the marshy and sickly districts of Eu- 
rope, more especially of France, Holland, Italy, Spain, and Portu- 
gal; for in some of them, where, by the operation of the poison, 

1 Diseases of the Mississippi Valley, 382. 

5 Fodc-re, Med. Leg. v. 105; topple, Fievres Intermit. 11; Eoudin, Fievres Inter. 
188; Diet, des Se. Med., article Marais, 533; Monfalcon, viii. 114, 131; Blair, Y. 
Fev. of Demerara, 23; Davy, Notes to Blair; Prony, Rapport sur les Marais Pontines, 
Becquerel, 170, 1 ; Edinb. Med. and Surg. Journ. Ixxx. 212; Thouvenelle, Climat 
de l'ltalie, 15, 16 : % Copland, art. Endemic Influences, i. 7G1, Am. ed. ; Carriere, op. 
cii. 87 ; De Eenzi, Miasmi Paludosi, 83. 

3 Essay on Malaria, 19. 



288 PNEUMONIA AND 

through a long and unbroken line of generations, the effect lias 
reached its maximum, the issue is deplorable. The adage, which 
attributed the dulness for which the Boeotians were proverbial to 
the mists and paludal nature of their ill-favoured country, is as old 
as the time of the ancient Athenians, and shows that, at an early 
period, the cachectic effect of such localities was matter of ob- 
servation. Hippocrates may have had them in his mind, when, in 
writing the famous treatise so often referred to, he remarked, that 
such waters "as are marshy and stagnant, and belong to lakes, 
are necessarily hot in summer, thick, and have a strong smell, since 
they have no current ; but being constantly supplied by rain water, 
and the sun heating them, they necessarily want their proper co- 
lour, are unwholesome, and form bile. Those who drink them 
have large and obstructed spleens, their bellies are hard, emaciated, 
and hot ; and their shoulders, collar-bones, and faces are emaciated ; 
for their flesh is melted down and taken up' by the spleen, and 
hence they are slender; such persons, then, are voracious and 
thirsty ; their bellies are very dry, both above and below. They are 
very subject to dropsies of a most fatal character; and, in summer, 
d}^senteries, diarrhoea, and protracted quartan fevers frequently 
seize them; and these diseases, when prolonged, dispose such con- 
stitutions to dropsies, and thus prove fatal. Women are subject to 
oedema and leucophlegmasia. The children are particularly subject 
to hernia, and adults to varices and ulcers on their legs ; so that 
persons with such constitutions cannot be long lived, but, before 
the usual period, they fall into a state of premature old age." 1 

Quod si 

Judicium subtile videndis artibus illud 

Ad libros et ad hsec musarum dona vocares 

Boeotum in crasso jurares aere natum. — Horace, Epistol. lib. ii. Ep. 2. 

Lancisi did not fail to notice the undermining effects on the mind 
and body of an atmosphere thus vitiated, and closes a long and inter- 
esting chapter on the subject with remarking, " Adeo colore pallidi, 
vitibus habetes, ingenio sunt tardo, muliebrique ;" 2 and that matters 
have not changed in that respect in Italy, since his days, may be 
easily (bund on consulting the works of Carriere, De Kenzi, Thou- 
venelle, and others. 

M. Bosse has furnished us with a graphic picture of the condi- 

1 Airs, Waters and riaccs, Adams's Transl. i. 105, 196. 2 Op. cit. lib. i. 70. 



AUTUMNAL FEVERS. 289 

tion of the inhabitants of the malarial districts of the Department 
of Ain (formerly the province of Bresse), in France. "A pale 
and livid complexion, a dull and heavy eye, swollen eyelids, a 
wrinkled face, narrow shoulders, a contracted chest, a long neck, a 
shrill voice, a skin always either dry or bedewed with debilitating 
sweats, a slow and sluggish walk, &c, characterize such an individual, 
who is old at thirty, broken and decrepit at forty or fifty." 1 

Not different is it in the malarial districts of our Southern States, 
for there the result adverted to is already visible. In those districts 
the human frame is weakly constituted, the mortality of children 
very great, and the mean duration of life short. " Along the fron- 
tier of Florida, and the southern borders of Georgia," says Dr. Forry, 
" as well as in the low lands of our Southern States generally, may 
be seen deplorable examples of the physical and perhaps mental 
deterioration induced by endemic influences. In earliest infancy, 
the complexion becomes sallow, and the eye assumes a bilious tint. 
Advancing towards the years of maturity, the growth is arrested, 
the limbs become attenuated, and the viscera engorged. Boys of 
fifteen years may be seen bowed down with premature old age — a 
mere vegetating being, with an obstructed, bloated, and dropsical 
system, subject to periodic fevers, passive hemorrhages, and those 
other forms of disease which follow in the train of malaria." 2 

These phenomena, which are indicative of that condition of the 
system denominated very aptly the paludal cachexia, are certainly 
not the usual results of the action of simple heat, cold, moisture, or 
atmospheric vicissitudes, or of the introduction into the system of 
any known gas; but point to the morbid influence of some spe- 
cial toxicological agent absorbed into the circulation along with the 
air we breathe, and possessing a twofold action, one chronic another 
acute; the former producing peculiar bad effects in the blood, in 
the liver, in the spleen, and the whole alimentary canal and vascu- 
lar system ; the other giving rise to periodic fever. 

Dr. Blair remarks that, in Demerara, " there seems to be both 
an ancemiating and a septic malaria. The former pervades the 
colony, so that a rosy cheek is nowhere to be found after a year's 
residence ; but it least affects the sea-shore. Its intensity increases 
as we proceed into the interior, up the narrow creeks and muddy 

1 Statistique du Department de l'Ain, 4. 

2 Forry, Climate of the U. S. 3G5, 3G6. 
19 



290 PNEUMONIA AND 

rivers. There, the complexion becomes perfectly etiolated, even 
without an attack of intermittent ; the spleen gets enlarged, the 
cellular tissue infiltrated, and dyspnoea and palpitations supervene 
from mere whiteness (loss of the red particles) and thinness of 
blood." (P. 23.) To this Dr. Blair's annotator, Dr. Davy, adds that 
such an influence seems to be common in the West Indies. " It is 
strongly marked by the pale, sallow, sickly hue of the white Creoles, 
especially in Barbadoes. There, if they have any colour, it is most 
frequently reddish ; whence the labourers of this class have been 
called ' red legs.' One rarely witnesses that bronzing of the ex- 
posed skin in the West, which is the almost constant effect of 
exposure to the sun's rays in the East Indies, and in the south of 
Europe." (lb.) 

In many southern regions, the West India Islands, for example, 
malaria predisposes, as Hippocrates informs us was the case in 
Greece, to ulcers. Of 6,395 admissions into the colonial hospital 
of Georgetown, Demerara, 1,873 were cases of ulcers. Small wounds 
produced by insects and serrated grasses, are sufficient to excite one 
in subjects so predisposed. The ulcers chiefly affect the lower ex- 
tremities ; but the fingers are sometimes affected, and even the lips 
and cheeks. In the negroes they are often large, with indurated 
edges, and produce not the slightest inconvenience, except in the 
trouble of dressing them. Among the emigrants, particularly the 
Portuguese and the Coolies, the ulcer is generally sloughy, phage- 
denic, bleeding, and sometimes a perfect sphacelus, without even 
surrounding or previous erythema. This last form affects those 
who have still a tolerably healthy appearance. In time, the soft 
and solid parts are speedily destroyed, and if amputation be found 
necessary, gangrene is apt to attack the stump within twenty -four 
hours. In the ansemiated immigrant Portuguese, the granulations 
are pale, and the progress of course is slow, but the sore will heal 
kindly. 1 Dr. Blair is of opinion that this septic modification of the 
malaria (which shows itself in the bleeding gangrenous ulcer) is 
some imperfect development of the yellow fever poison. Dr. Davy 
remarks, in support of this view: "In Barbadoes, among the 
white natives, who are almost always exempt from yellow fever, 
the mucous membranes, especially of the primce vias, and the skin, 
are very prone to diseased action of a kind bearing some resem- 

1 Blair, 23. 



AUTUMNAL FEVERS. 291 

blance to what is witnessed in yellow fever; for instance, the chap- 
ping of the lips, with ulceration and bleeding; an aphthous or 
slightly ulcerated state of the fauces, and probably of the gullet and 
stomach ; the yellowish sallowness of skin, with tendency to ulcera- 
tion. I may add that, during the absence of yellow fever amongst 
the troops, a disposition to purpura hemorrhagica is occasionally 
witnessed." 1 

Effect of a paludal atmosphere on the duration of life. — ISTor is it to 
be forgotten that, for the above reason, a paludal atmosphere has 
the effect of shortening the duration of life. Dr. K. Jackson states, 
as the result of observations made during the period of our revolu- 
tionary war, that white females, born and constantly residing in the 
lower districts of Georgia, were seldom observed to live beyond the 
age of forty, and males of fifty. He adds, that he was credibly 
informed there was not on record an instance of a person born at 
Petersburg, Ya., and constantly residing there, who had lived to 
the age of twenty -one. 2 Either the distinguished writer was misin- 
formed, or matters have greatly improved in that vicinity ; for the 
average duration of life is infinitely greater now than he represents 
it to be. But still, at present, the fenny districts of Virginia give 
but a low average. Dr. James Johnson found that in the valleys of 
Beveland and Walcheren, the peasants exhibited conspicuous marks 
of premature old age, and seldom reached beyond fifty -five or sixty 
years. 3 According to Sausset, the average duration in fenny 
countries is not over twenty-six years. In many districts of 
France, it does not exceed twenty-two. 

Eozier, quoted by Monfalcon, fixes at fifty years the farthest 
limit of human life of the inhabitants of Lower Brittany ; the old 
age of whom, when they have attained this point, bears a great 
resemblance to that of individuals who, in salubrious countries, 
have reached to ninety. 4 It would be difficult to find a locality 
where other than a toxicological cause con Id produce such disas- 
trous results on an entire population. From the researches of M. 
Fleuriau cle Belle vue, we learn that the mortality of some com- 
munes around Marenne amounts to one in thirteen, and that that of 
the Canton of Brouage, during a period of sixteen years — 1817- 

1 P. 24, note. 2 Treatise on the Fevers of Jamaica, 77, 80. 

3 Trop. CI. 41. 4 0pt cit 134p 



292 PNEUMONIA AND 

1832, presents a proportion of one to twenty-one. 1 The same 
writer remarks, in farther illustration of the deleterious effects of 
paludal localities, in relation to the subject under consideration, 
that inundated and well-shaded marshes were found to be as healthy 
as dry and well-cultivated fields — the mortality being one in from 
42 to 46 ; that in districts possessing a purely compact argillaceous 
soil, unsheltered from the rays of the sun, and on which rain-water 
remains stagnant for some time, the mortality was one in 25, and even 
one in 20 ; and that in five cantons containing several large regular 
marshes, the mortality amounted to one in 18, and even reached as 
high as one in 16. 2 In the Bresse and Dombes, the proportion is also 
one to twenty-one ; while in the immediate vicinity, the proportion 
is much less unfavourable, being from 1 to 25.6 to one to 26.7. 3 In 
the Department of Loiret (canton of La Ferte and Sully, but not 
including the town of Sully), the average duration of life is 23.33 
years. In the Department of Loir et Cher (cantons of La Motte, 
Beuvron, Neung, Eomorantin, and Salbris), the average is 29.41. 
In other less malarial cantons, it is 30.04, 30.64, and 34.34. 4 

France, taken in its ensemble, exhibits a loss on one in about 
forty ; from which it follows that the number of deaths in the 
aforesaid malarial districts is twice as large as it is in the country 
generally, and that the average of life is proportionably less. 
Among children, the loss has been particularly large, amounting 
during the first year to thirty -two per cent. ; and in some communes 
to forty-two per cent., or four-tenths (near one-half), while in the 
entire of France the proportion is only twenty-three or twenty-four 
per cent. 5 

To the same effect, I may call attention to a fact mentioned by 
Dr. Price, in a work which has justly acquired a great reputation. 
Eeferring to the District of Yaud, in the Canton of Berne (Switzer- 
land), the population of which amounted to one hundred and sixty- 
nine families, representing a total of six hundred and ninety-six indi- 
viduals, he remarks that of these, one-half of all born in the mount- 
ains live to the age of forty-seven ; whereas, one-half of all born in 

1 Statistique dc la Charente Inferieur, quoted by Melier, Mem. de l'Ac. de Med. 
xiii. 667. 

2 Comptcs de l'Acad. des Sc. xxv. 338, 339. 

3 I-ndi'ie, Medecine Legale, v. 1G3; Nepple, Fiev. Interm. 11. 
1 Etoquerel, Des Climats, 265, 266. 

6 M6m. dc l'Acad. de Medecine, xiii. 667. 



AUTUMNAL FEVEKS. 293 

the marshy portion of the district, reach only to the age of twenty- 
five. One in twenty, of all born on the hills, live to eighty ; only 
one in fifty-two attain this age in the marshy portion. Hence, he 
observes, the probabilities of living are highest in the most hilly 
parts of the district, and lowest in the marshy. In the former, a 
person aged forty has a chance of eighty to one for living a year. 
In the marshy localities of the district, his chance is not thirty to 
one for living a year. In the former, again, persons aged twenty, 
thirty, and forty, have an even chance for living to forty-one, thirty- 
three, and twenty -five years respectively ; in the latter, on the other 
hand, persons at these ages, have an even chance of living only 
thirty, twenty, and fifteen years. 1 

The effects of malaria on population are well illustrated by the 
results of observations made in the Pontine Marshes, where, not- 
withstanding the great ameliorations effected in their condition 
from 1801 to 1811, the mortality has almost always exceeded the 
births : — 







Localities. 








Velletri. 


Serra. Poperino. 


SoRINOI. 


Total. 


Deaths . 


. 2,313 


3,181 1,717 


901 


8,112 


Births . 


. 1,786 


3,338 1,601 


885 


7,610 



Even in France, where malarial fevers are not as malignant as 
they are in warmer latitudes, the difference is considerable. Take 
the ten most malarial departments, and compare them with the ten 
least so, and it will be found, in 1846, that the former presented a 
smaller proportion of births and a larger proportion of deaths than 
the latter: — 

Ten least malarial departments. Ten most malarial departments. 

Births .... 1 in 34.09 1 in 34.40 

Deaths .... 1 in 46.61 1 in 41.08 

Increase of population T Jg T ± ? 2 

Cause of fever "produces an impress of greater or less strength on all 
placed under its influence. — The existence of a peculiar morbific agent 
floating in the atmosphere of malarial localities, and differing from 
the causes of ordinary diseases, may be inferred from the fact that 

1 Annuities and Lives, ii. 29; ih. Letter to Dr. Horsley, on "Insalubrity of Marshy 
Situations," Philos. Tr. of London, lxiv. 96. See also Sir J. Sinclair, Principles of 
Hygiene, 84. 

2 Becquerel, Tr. Elem. d'Hyg. Privee et Publique, 193. 



294 PNEUMONIA AND 

in such localities all individuals are more or less, especially in times 
of severe epidemics, under the influence of the cause, and, without 
beino- necessarily ill, give evidence of that influence by presenting 
in a minor form some of the symptoms of the prevailing disease. 
By those who have noticed the progress of Asiatic Cholera, and of 
the wide-spreading Pneumonia Typhoides which traversed this 
country in 1812, 1813, and who have read of the sweating disease 
of 1483-85, and of the Black Plague of the Middle Ages, it will be 
remembered that besides the many who were attacked with those 
complaints in full force, thousands suffered from some one or more 
of their characteristic marks in a mitigated form. Phenomena of 
an analogous kind result from the action of the causes giving rise to 
remittent and intermittent fevers, yellow fever, and other affections 
of similar nature ; for, during the prevalence of epidemics of these, 
a large number of individuals exposed suffer from slight indisposi- 
tions, and exhibit in a variety of ways the impress of the morbific 
agent. On this subject, the facts recorded by Push, 1 Mitchell, 2 
Potter, 3 Archer, 4 Schnurrer, 5 Boudin, 6 Holmes, 7 Chervin, 8 Pariset, 9 
Perlee, 10 and others, leave no doubt; and show the effect to have 
borne on the eyes, on the secretions, on the alimentary canal, on 
the brain and nerves, and on the blood. All this is explainable on 
the supposition of a toxical agent floating in the atmosphere and 
producing a morbid impress of greater or less force on all, but 
cannot be accounted for if we refer the disease to the operation of 
heat, cold, humidity, atmospheric vicissitudes; in a word, to any 
known modification in the sensible qualities of the air. 

Kindred phenomena, resulting from the gradual operation of 
morbid agents, the true toxical nature of which is undeniable, are 
matters of frequent observation, and serve to confirm the views here 
suggested. M. Tanquerel des Planches, in his excellent work on 
lead diseases, remarks: "Saturnine preparations, when introduced 
into the system, indicate their presence there before the manifesta- 
tion of lead diseases by a specific action on most of the solids and 
fluids." This action, which he denominates primitive introduc- 

1 Vol. iii. 84, 85. 2 Med and pi^g. Register, iv. 188. 

3 On Contagion, 55. < Med. Recorder, v. 68. 

' Materiaus pour servir a line doctrine des epidemies, 40. 

6 Fievrcs [ntenn. 188. < Am. J. of Med. Sci. N. S. xii. 308. 

v FiiviT .1. d'Espagne, 174. 9 Fievre J. de Barcelone, 27. 

"' Philad, Med. and Physical J. iii. 12, 13. 



AUTUMNAL FEVERS. 295 

tion, consists in, 1st, a peculiar discoloration of the teeth, and 
lining membrane of the mouth ; 2d, the saturnine smell, taste, and 
breath ; 3d, the saturnine action, or yellow leaden hue of the coun- 
tenance ; 4th, the remarkable emaciation of the face. 1 

The cause of autumnal fevers produce an impress on the lower order 
of animals and on vegetables. — The cause giving rise to the febrile 
affections, which are usually referred to some one or other of the 
modifications of malaria, extends its influence to the lower orders of 
the animal creation, and even to vegetables. In this and other cities 
of the United States epidemics of malignant fever have often been 
ushered in and accompanied by sickness among cats, dogs, hogs, 
&c. 2 Similar observations have been made elsewhere — the symptoms 
being often analogous to those of the reigning disease, 3 while epi- 
demic seasons have often been found marked by a great predomi- 
nance of insect life. The coincidence of blight with pestilence has 
been recorded from ancient times. M. Dupuy has seen a number 
of oxen perish with symptoms perfectly analogous to those of inter- 
mittent fever, after having pastured in a highly marshy locality. 
In 1826, after the overflow of the Eiver Manse, an intermittent epi- 
demic broke out among horses, and occasioned a considerable mor- 
tality. Lancisi relates that, in 1713, during the prevalence of 
intermittent fevers, an epizooty carried off thirty thousand oxen. 4 
It should be added, also, that marshes occasion, among many ani- 
mals, " a chronic enclemy, perfectly analogous to that produced in 
the human species. The prolonged sojourn and pasturage of sheep 
in marshy localities produce in them the hydroasmia, a disease cha- 
racterized by a diminution in the proportion of the blood-globules, 
as also by a notable one in the quantity of the serum, and which, 

1 See also Adams's Rept. in Trans, of Am. Med. Assoc, v. 171, 172. 

2 Med. Repos. i. 250, 254,5, 351; Smith (E. H.) Fev. of N. Y. 76; Caldwell, 133, 
169; ib. fever of 1805, pp. 40, 61 ; Condie and Fohvell, 15 ; Rush, iv. 8; Shecut, 77 ; 
Vaughan, 18 ; Cartwright, Recorder, ix. 7 ; Baxter's Med. Repos. xxi. 6, 7 ; Chap- 
man, Med. and Phy. J. ix. 395, 6 ; Kilpatrick, N. 0. J. ii. 43; Seaman Webster's Col- 
lection, 3 ; Thouvenelle, iv. 200-202. 

3 Smith, Edinb. J. xxxv. 36 ; Maclean on Epid. i. 289 ; Sir J. Fellows, 45, 236 ; 
Cycl. of Pract. Med. ii. 74; Pariset, 67-69; Osborn, 70; Pinckard, i. 138; Des- 
portes, i. 17; Arejula, 286, 331; Ralph, Ed. Med.-Chir. Tr. ii. 58; O'Halloran, 26; 
Melier, he. cit. 669 ; Rep't on Quarantine, London, 13 ; Second Rep. 39, 365 ; Mo- 
reau de Jonnes, 112; King's Rep't on Fever of Boa Vista, 9; Blair, 63; Boudin, 
Fiev. Int. 135; Monfalcon, 502. 

4 Lancisi, De Boville Peste, 2, &c. 



296 PNEUMONIA AND 

consequently, is analogous to the paludal cachexia of men." M. 
Gasparin reproduced this disease in sheep by causing them to drink 
and to be rubbed with the condensed vapour obtained from marshy 
surfaces. * 

Mr. Chaclwick informs us that in the course of the inquiries as to 
what has been the effect of drainage upon health, one frequent 
piece of information received has been, that the rural population 
has not observed the effects on their own health, but they have 
marked the effects of drainage on the health and improvement of 
the stock. Thus, the less frequent losses of stock from epidemics 
are beginning to be perceived as accompanying the benefits of 
drainage, in addition to those of increased vegetable production. 2 

The General Board of Health of London, in their Eeport on the 
practical application of sewer- water and town manures, already re- 
ferred to, remark that the injurious effects upon health, of the pro- 
longed retention of excessive moisture on a surface of vegetable 
mould, is established by the production of rot amongst sheep — an 
effect which sheep-feeders have produced by stocking closes just 
after they had been flooded, and whilst they were saturated with 
moisture. 3 

In his examination before the Metropolitan Sanitary Commis- 
sioners, already referred to in a former chapter, Mr. Smith, after 
speaking of the beneficial effects of draining on the healthiness of 
malarious localities, remarks that it is generally observed by the 
inhabitants, that their cattle or stock are now less subject to dis- 
eases. In a farm in the west of Perthshire, the cattle were very 
subject to the disease called "reel water;" since the draining, there 
has been no case of that disease. In other parts of Scotland and 
England, similar results are stated to have followed the introduction 
of thorough drainage. 

Mr. Parker stated that the disease of foothalt in sheep and deer 
has been perfectly removed in many gentlemen's parks, and in ex- 
tensive pasturage grounds, by deep under drainage. 

" In the Highlands," Mr. Spooner remarked, " and more particu- 
larly on the west coast, there exists a well known and fatal disease 
among sheep, incurable by any treatment, termed ' Braxey,' which 
"ii undrained land, and in wet seasons, is a cause of very serious 

1 Bepquerel, Hygiene, 183, 194, 195. 

2 Second Rep't of Commissioners of Inq. into the State of Large Towns. 

3 P. 9, Loudon, 1852. 



AUTUMNAL FEVEES. 297 

losses. This is, in a great measure, prevented by drainage, and the 
diminution of casualties alone is more than sufficient to cover its 
cost, independently of the increased quantity and better quality of 
the fodder produced. This system has been extensively practised 
for several years, and invariably with the same beneficial results. 
As to the health of cattle or stock," he added, " I have the strongest 
evidence of the beneficial effects of drainage in many instances. On 
the lands which I possess, and on several others in the district, a dis- 
ease called ' red water' prevailed, in some years proving very fatal ; 
but after drainage and cultivation of the marshy parts of the pas- 
turage the stock has been free of that disease. The surface drain- 
age of sheepwalks in every district is well known to promote the 
healthiness of the stock, and I believe the thorough drainage of a 
single swamp in any locality will be an important means of im- 
proving the health, both of the population and stock connected 
with it." 1 

In farther corroboration of this, it may be remarked that it has 
been found in this country that those animals that feed in marshes 
where periodic fevers prevail, have diseased viscera. We are told 
by Dr. Ludlow, that in the town of Wolcott, Seneca County, 1ST. Y., 
where marshes and lowlands abound, the hogs, when killed, are 
generally found to have eroded livers. 2 

The history of the Oriental plague furnishes striking examples 
of the influence of the morbid cause on the lower order of ani- 
mals. 3 It has been noticed from the earliest period ; is mentioned 
by poets 4 and historians, 5 and recorded in holy writ. 6 

It is certain, also, " that seasons which are unusually sickly to 
large classes of human beings, are often alike unfriendly to the 
health and fruitfulness of many classes of plants." 7 Fodere, in 
speaking of the Marshes of Bresse, in France, remarksithat animals 

1 Drainage of the Land forming the Sites of Towns, 69, 70. London, 1852. 

2 New York Med. and Phys. Journ. ii. 88. 

3 Hippocrates ; Santi Romeo — Ricerche Sulla Peste Borbonica ; Diego Picollo, de- 
scription de la Peste de Mission, chap. 2, 128; Aubert and Etienne, cited by Clot- 
Bey, 257; Thos. Leslie Greyson, Rep. of Quarantine, 14; Schiller, 257; Short, 
Cbron. Hist, of the Weather and Dis. of Lond. 338; Hancock, 101. 

4 Homer, Iliad, book i. 67, 70 ; Lucretius, lib. vi. 1117 ; Ovid, lib. vii. 523. 

5 Thucydides, xi. 52 ; Livy, 3, 6, 571 ; Dionysius, lib. xx. 

6 Exodus, vii. 7; xvii. 18; viii. 17; ix. 15. 

7 Report on Quarantine (London), 14; see also Chapman on Epid. Med. and Phys. 
Journ. vii. 256; Rush, 56; Caldwell, 133; Condie and Folwell, 13; Thouvenel, 200. 



298 PNEUMONIA AND 

and plants are there of a small and feeble complexion, stunted in 
appearance, and endowed with a small degree of vital force ; and 
Boudin, who refers to this fact, states that he has seen plants which 
were transplanted in marshy localities deteriorate rapidly, and re- 
turn to their normal state as soon as they were removed beyond 
reach of the paludal influence. 1 

The great diffusion and mortality of autumnal fevers is explained only 
on the supposition of the cause being a gaseous poison. — To no other than 
a truly toxical agent, suspended in or mixed with the atmospheric 
air, can we refer diseases which affect in a similar way, and such 
rapid succession, so large a number of individuals, and occasion 
often so extensive a mortality. No modification in the sensible 
qualities of the air of a given locality ; no atmospheric vicissitude, 
however frequent and extensive, has been known to produce such 
effects. A single regiment, in Africa, with an effective force of 
seventeen hundred men, sent, in the short space of six weeks, one 
thousand and fifty to the hospital, and mostly for intermittent and 
remittent fever. In 1830, the whole of another regiment was sent 
to the hospital. In the same year (1830), the number of admissions 
in the Hospital of Buffarick amounted to 2,386; and of these 1,491 
were affected with intermittents. 2 According to Dr. Maillot, 22,330 
cases were admitted in the Hospital of Bone, from the 16th of 
April, 1832, to the 16th of March, 1835. Of these, 2,513 died. 3 
So common is ague in many parts of Spain and Portugal, says Sir 
James Macgrigor, 4 "that the inhabitants do not term it a disease." 
Facts will bear Dr. Williams out in the remark, that the invasion 
of the Burmese and of the African empires has, in each instance, 
been so disastrous to the troops, that the whole force must have 
perished from this class of diseases, in a few months, but for the 
success of their arms in the one instance, or their being withdrawn 
from the pestilent atmosphere in the other. 5 The British forces in 
the Islands of Zealand, amounted, on the 25th of August, 1809, to 
41,6-12 men, and 1,879 commissioned officers. Between the 21st of 
August and 18th of November, the number of sick, almost exclu- 
sively from fever, amounted to 26,846, including relapses. 6 

1 Fievrea Interna. 198. 

2 Gouraud, Fiev. Interm. 200. s Y\ex. Tnterra. 276. 

1 Med.-Chir. Trans, vi. 415. 5 Morbid Poisons, ii. 4-57. 

" Kane, Dissert i. 226, 227; Bee also Marshall, Edin. J. xlviii. 308, 300. 

The disease began to snow itself between the 15th and 20th of August. On the 



AUTUMNAL FEVERS. 299 

Dr. Wind, who translated into Dutch Dr. Lind's essay on pre- 
serving the health of seamen, and who practised medicine in "Wal- 
cheren for many years, informs us that the Scotch regiment in the 
Dutch service has been known to bury its whole numbers at 
Sluys, in Dutch Flanders, in three years. AVe learn from the 
reports of Dr. Borland and his coadjutors that, upon an examina- 
tion of the sick returns of the French army for a period of seven 
years, it was found that at least one-third, or 33 per cent, of its 
force was annually cut off by endemic diseases. I may add that, 
when the English landed in Walcheren, there were only eighty-five 
men alive in a Dutch regiment, which, at its arrival there, three years 
before, was 800 strong. The annual ratio of mortality of this corps 
must have been about 31 per cent., or rather more than double the 
mean ratio of mortality which occurs among troops in Jamaica. 
Xapoleon seems to have known pretty well the real nature of the 
climate of the Delta of the Scheldt, and of its influence upon 
strangers ; for, in a letter to the Minister of "War, in regard to the 
TTalcheren expedition, he says : " AYe are rejoiced to see that the 
English themselves are in the morasses of Zealand. Let them be 
only kept in check, and the bad air and fevers peculiar to the cli- 
mate will soon destroy their army." The French, it is said, crowed 
over the expedition with the force of reason, the bitterness of sar- 
casm, and the playfulness of ridicule. 1 

Some fifty years before, Sir John Pringle, in tracing the influence 
of paludal exhalations on the British troops in Flanders, during the 
campaign of 1748, stated that they had scarcely been a month in 
the cantonment, when the return of the sick amounted to 2,000. 
One regiment, the Greys, cantoned in Yucht, a village surrounded 
with meadows, either then under water or but lately drained, were 
the most sickly. At the end of five weeks they returned about 
150; after two months, 260, which was one-half of their number; 
and, at the end of the campaign, they had in all but thirty men 
who had never been ill. Another resriment, at ISTieulancl, where the 

29th, the number of sick amounted to little less than 3,000 men. On the 30th, 200 
of the artillery, 130 of the 36th, 300 of the 26th, 250 of the 71st, 200 of the 84th, and 
the whole of the 23d, with the exception of about forty, were in the hospitals. Early 
in September, there were upwards of 7,000 on the sick list. On the 14th, it was esti- 
mated that, of 15,000 in Walcheren, 10,000 were actually sick. Of one regiment 
alone, the 38th, the sick return was 11 officers and 459 men. — Davis, A Scientific and 
Popular View of the Fever of Walchere?i, 9, 12, 14, &c. 

1 Marshall, Statistics of the Walcheren Expedition, Edin. J. xlviii. 313. 



300 PNEUMONIA AND 

meadows had been floated all winter, and were but just drained, 
returned sometimes above one-half of their number. Another, 
again, the Scotch Fusiliers, at Dinther, had above three hundred ill 
at one time. 1 The same distinguished writer informs us that when 
four battalions of British troops, which had been employed in 
Zealand during the year 1747, went into winter-quarters, their sick, 
in proportion to the men fit for duty, were nearly as four to one, 
which is equal to 800 per 1000. 2 

At Fort Charlotte, in the rear of the town of Nassau, Bahamas, 
nearly the whole of the 47th Kegiment, including women and chil- 
dren, were swept off within a short time. In 1802, 220 out of 300 
perished. Of seventy men, sent there in 1818, forty died in six 
months ; besides thirteen women and children out of thirty-seven. 3 
In relation to the sickness in Jamaica, Dr. Hunter states that four 
regiments were sent from England in 1780. They arrived on the 
first of August. Less than six months after, one-half of them 
nearly were dead, and a considerable part of the remainder unfit 
for service. 4 

At the period of the English fleet anchoring in the Eangoon Eiver, 
on the 10th of May, the troops mustered between 5,000 and 6,000 
men. By the end of June, fever had so diminished the number, 
that, even after reinforcements, scarcely 3,000 troops were left to 
guard the lines. 5 Of the effects of exposure to the African coast, 
the results of the Niger expedition will testify. On that occasion 
three vessels entered the river — the Albert, the Wilberforce, and 
the Soudam ; the first with 62 white men aboard, including officers ; 
the second with 56, and the last with 27. The Albert remained 64 
days in the river ; the "Wilberforce 45 days, and the Soudam 40. 
In that short space of time, the number of fever cases in the three 
vessels, with a total force of 145 whites, amounted to 130, or one 
in 1.12 ; and that of deaths to 40, or one in 3.6. 6 

At Sierra Leone, an aggregate strength, in eighteen years, of 
1,843 white soldiers furnished not less than 2,600 cases, being in 
the annual ratio of 1.411 per 1,000 of mean strength; while the 
mortality amounted during that time to 410.2 per 1,000. 7 In the 

1 Dis. of the Army, 56, 59. 2 Pringle, 65, 66. 

3 Second Report on Quarantine, 59. 4 P. 11. 5 Williams, ii. 457. 

6 McWilliams, Med. Ace. of the Expedition of the Niger, 126-128. 

7 Tullock, llept. of Sickness, Mortality, &c, among Troops on the West Coast of 
Africa, 8. 



AUTUMNAL FEVERS. 301 

Cape Coast command, the aggregate strength, in four years, being 
630, the number of cases of remittent fever alone did not fall short 
of 500, with an annual mortality, from the whole class, of 382.6 per 
1,000 of mean strength. 1 In a preceding part of this volume, atten- 
tion was called to the fact that in the Jamaica command, with an 
aggregate force, in twenty years (1817-1836), of 51,567 men, the 
number of cases of malarial fevers amounted to 46,922, being in the 
proportion of 910 per 1,000 of the mean strength. In the wind- 
ward and leeward commands, an aggregate strength of 86,661 gave, 
during the same period, no less than 62,168 cases, or 717 per 1,000. 
Honduras, where the aggregate strength of the white soldiers, in 
fifteen years, did not exceed 320 men, there were 221 cases of fever, 
or 690.6 per 1,000. 2 

A detachment of the 98th Eegiment, quartered on a height in 
Happy Valley (Hong-Kong, China), experienced a mortality, within 
six months, amounting to 25 per cent. In a locality called West 
Point, at least one-half of the whole force is supposed to have been 
lost by death or invaliding. In the summer of 1843, the fever was 
so fatal, in some parts of Hong-Kong, that it cut off 100 from a 
total of 300 civilians residing upon the island. 3 

In this city, during the memorable epidemic of 1793, when the 
population fell short of 50,000, the number of cases may be esti- 
mated to have amounted to little less than 11,000, or 200 per 1,000; 
with a mortality of about 3,500, or 70 per 1,000 of the population. 

New Orleans, in 1847, contained a population estimated at 
109,000. Of these, 20,000, or 184.31 per 1,000, suffered from the 
yellow fever. Two thousand eight hundred and eleven cases were 
reported, and of these 895 died. The population of Woodville 
(Miss.) amounted, in 1845, to 800. Of this number, 595 passed 
through the disease in one or other of its various forms ; being in 
the proportion of 74.4 per cent. It is to be borne in mind that 200 
of the inhabitants left the village early, so that disease, in fact, bore 
on a population of 600, and therefore attacked them in the propor- 
tion of 99.17 per cent. The population of Cadiz, in 1800, is stated 
to have been 71,491. Of these, 48,520 were attacked with the 
reigning epidemic; being in the proportion of 678.7 per 1,000. In 

1 Ibid. 20. 

2 lb. Sickness and Mortality of Troops in West Indies, 7, 44, 45, 77. 

3 Barton, Fever of Hong-Kong, Dublin J. No. 24, p. 440, 441, N. S. 



302 PNEUMONIA AND 

1819, the results were scarcely different. In Seville, in 1800, the 
proportion was larger still; the population being 80,568, the 
number of cases 76,488, or 919.4 per 1,000, and the deaths 14,685. 
In Alicant, in 1804, out of a population of 13,000, 9,000, or 692.4 
per 1,000 had the disease, and 2,472 died. 1 As I am writing these 
lines (November 24), the melancholy accounts received from New 
Orleans, exhibit a mortality there, this year, from yellow fever, of 
40 in June, 1,406 in July, 5,189 in August, 1,070 in September, 
and 139 from the 1st to the 22d of October, making a total, with 
three in- May, of 7,847. 

During an epidemic of pernicious or malignant intermittent fever, 
which occurred in Bordeaux in 1805, and is ably described by Dr. 
Contanceaux, it is estimated that twelve thousand individuals 
passed through the disease, and that one-fourth of these died. 2 
The fever which swept over the Coromandel in 1809, 1810, and 
1811, caused the loss of 106,789 out of a population of 1,828,610. 
Coimbatore lost in sixteen months 22,451 out of 596,606; Madura, 
in twelve months, lost 24,626 out of 245,654; Dendigul, in the 
same space of time, had 21,510 deaths in 29,654 individuals; while 
at Tinnivelly, the mortality, in the short space of five months, 
exceeded 38,000 in a population of 690,696. 3 

"It is remarkable," says Lind, "that, in the war which terminated 
in 1763, the English ships of war which touched at Batavia, suffered 
more by the disease of that climate, than they did in any other part 
of India, if we except a malignant scurvy which once raged in the 
fleet at sea. Soon after the capture of Manilla, the Falmouth, a ship 
of fifty guns, went to Batavia, where she remained from the latter 
end of July to the latter end of January, during which time she buried 
seventy -five of her crew and one hundred soldiers of the 70th Regi- 
ment, who were embarked on board of her, not one person iu the 
ship having escaped a fit of sickness, except her commander, Captain 
Brereton. The Panther, a ship of sixty guns, was there in the years 
1762 and 1764, both times, unhappily, during the rainy season. In 
the year 1762, she buried seventy of her men, and had ninety-two 
very ill when she left the place. In the year 1764, during a short 

1 See an Essay on the Mortality of Yellow Fever, by the present writer, Charleston 
Med. J. vii. 4G3. 

2 Notice sur les Fievres Pernicieuses qui ont regn^ a Bordeaux, en 1 805. 

3 Med., Geog., and Agricult. Rep. on Fever of Coimbatore, &c., by Ainslie, Smith, 
and Christy, Lond. 1816, p. 93, &c. 



AUTUMNAL FEVEES. 303 

stay, she buried twenty-five of her men. The Medway, which was 
there in company with her, lost also a great number of her men." 
The fever was of the remitting kind. 1 

In addition to the facts already adduced, the attention of the 
reader might be called to the wide diffusion and excessive mortality 
noted during some epidemics of glandular plague. He might be 
reminded that, in London, in 1625, it carried off not less than 
35,417 individuals, according to Grant, 2 and 46,000, according to 
the calculation of Short ; 3 that, in the same city, the mortality, forty 
years after (1665), amounted to 97,000, 4 in a population of less than 
500,000; that, in 1812, the loss at Constantinople amounted to 
159,534 ; 5 and that in Lyons, in 1628, 29, in a population of some 
200,000 ; 6 fifty thousand persons were destroyed by the same disease. 
They might also be told that, at Montpellier, the number of deaths 
in 1629 fell but little short of one-half of the inhabitants who had 
not left the city ; 7 that, in Marseilles, the loss from the memorable 
pestilence of 1720, amounted to forty thousand ; 8 that at Noja, in 
1815-16, the number of cases in a population of 5,300 reached 
1,474, and the deaths 716 ; 9 that at Cyprus, in 1760, the disease de- 
stroyed 70,000, out of a population of 600,000 ; 10 again, that at 
Aleppo, the population of which amounted to some 60,000, it car- 
ried off in two years (1761, 62)about 21,800, n and that, in 1835, the 
loss in Cairo was little short of 26,000." 12 These and other instances 
of like import, might be specially adduced for the object under 
present consideration ; but as the question of the malarial origin 
of the Oriental plague continues to this day to be a subject of 

1 Hot Climates, 102, 103. Chisholm states that, in the year 1795, the Majestic, 74, 
Admiral Sir John Laforey's ship, while shut up, during the hurricane months, within 
a little landlocked bay, situate in the great bay of Fort Royal, Martinico, called Les 
trots ilets benits, and not inappropriately named, by the French, Gouffre de la Mort, lost 
in seven weeks one hundred and eighty-nine men. During the same months of 1796, 
Admiral Harvey's ship, the Prince of Wales, lay at the same place, and lost ninety- 
seven men. (Manual of the Climate, &c. of Tropical Countries, 20.) 

2 Natural and Political Observations, &c. made upon the Bills of Mortality, 8. 

3 New Obs. on Bills of Mortality, 274. 

4 Short, op. cit. 292 ; Marshall, Stat, and Mortality of the Metropolis, 66. 

5 Brayer, Neuf. Annees a Constantinople, ii. 248. 

6 Papon, De la Peste, Ou les Epoques Memorables de ce Fleau, i. 184. 

7 lb. 195. 8 lb. 343. 

9 Moreo, Storia della Peste de Noja, 25 ; Tavola, 3. 

10 Russell on the Plague, 8. " lb. 
12 Boudin (from Gaetani Bey), Geogr. Med. 14. 



304 PNEUMONIA AND 

doubt among those most conversant with the disease, I shall not 
insist upon them here. 

Let this he, however, as it may, the facts already mentioned, no 
less than the circumstance that, in times of violent epidemics, the 
early cases, very generally, prove fatal, are with difficulty explained 
on the supposition of those diseases resulting from the action of 
any other cause than a morbid poison diffused in the atmosphere of 
infected localities. Under no circumstances have diseases, undeni- 
ably produced by mere changes in the sensible qualities of the air, 
been found to spread so widely, to occasion so extensive a mor- 
tality, and to assume so usually a more malignant and fatal charac- 
ter at the outset of their prevalence. 

Autumnal fevers under the influence of various exciting causes. — In- 
dividuals exposed to the atmosphere of paludal localities in sickly 
seasons, or residing in cities visited by malignant and other fevers, 
become affected with the disease therein prevailing from the opera- 
tion of a variety of exciting causes. Insolation, exposure to rain, 
or to a current of cold air, a fit of intemperance, or the free use of 
stimulating drinks, excessive fatigue, irregularity of diet, a blow, 
a fall, a surgical operation, the loss of blood, a moral affection, an 
intercurrent complaint, &c. &c. will bring on an attack of the pre- 
vailing fever. It cannot be presumed that all these morbid influ- 
ences, differing as they do so materially from each other, are capa- 
ble of producing, unaided by some more efficient and special cause, 
one and the same disease. Hence, their agency must be limited to 
the placing suddenly the system, by the disturbance or shock they 
therein occasion, in a condition required to enable it to be mor- 
bidly affected by a cause of a more general character, producing an 
impression on all exposed to it, and occasioning, when it meets sub- 
jects suitably predisposed, a particular and specific set of morbid 
phenomena similar in all that are attacked. We know of no dis- 
eases, except those owing their origin to the action of morbid poi- 
sons, that can thus be brought out by perturbating agencies of the 
kind mentioned ; and the fact of the circumstance being observed in 
regard to intermittent and other fevers of like nature, lends a strong 
support to the opinion that the cause which gives rise to them 
consists in a poison of the sort floating in the air of the sickly 
locality. 



AUTUMNAL FEVERS. 305 

The r malarial origin of such fevers confirmed by the violent manner 
the cause often acts. — I might enlarge, in addition, on the circum- 
stance that the efficient cause of fever approximates in nature to all 
morbid poisons by the suddenly violent and disorganizing effects it 
produces in the system ; for though, when applied in a lesser force 
and in a gradual manner, it will give rise, as we have seen, to 
derangements of the viscera, and consequent ill health, without, 
however, exciting the usual symptoms of marked febrile affections; 
though, in other instances, the application of the cause occasions 
fevers of a comparatively mild character, running their course in 
a few days, yet in some instances death rapidly or even suddenly 
follows exposure to sources of infection ; so rapidly, indeed, that 
dissection reveals no traces of structural lesion. In all epidemics 
of yellow fever, while the duration of the disease extends generally 
to the third, fifth, or seventh days, and in some few instances much 
beyond, cases occur 1 in which it closes fatally in twenty-four, or 
even in a very few hours, without leaving any posthumous sign of 
local determination. Eesults not very different are observed in 
that form of malarial disease which has received the name of con- 
gestive fever as well as in malignant or pernicious intermittents. 
The system, in such cases, is at once prostrated, and the patient 
sinks without having manifested the least sign of a healthful reac- 
tion. In no diseases, but those originating from the action of mor- 
bid poisons, do we meet with occurrences of the kind. 

The cause of fever extends its action to the foetus in utero. — I might 
also refer as illustrative of the true toxical character of the efficient 
cause of fevers — of its analogy to other morbid poisons, and to 
the fact of its producing, like these, its deleterious impression 
through the blood, and consequently of its power of solution ; that 
it is known to affect the foetus in utero, and the infant at the breast. 
Need I remark, that cases are on record to show that the smallpox 
has been transmitted from the mother to her unborn offspring ; — 
children coming into the world with well-characterized pustules 

1 Rush, iv. 13; Deveze, 28; Caldwell, 85-87: Lining, ii. 426; Manson, 181; 
Baxter, Repos. xxi. 3 ; Gros. 13 ; Dickson, Chapman, J. iii. 256; Thomas, 89; Ber- 
the, 79 ; Arejula, 161 ; Jackson, Fever of Spain, 45 ; Pym, 60 ; Palloni, 6 ; Rochoux, 
519, 568; Warren, Fever of Barbadoes, 16; Gilbert, 66, 73; Bally, 272; Caillot, 
22, 23; Chisholm, i. 194; Moseley, 440; Imray, Ed. J. liii. 82; Bancroft, 35; Wil- 
son, 7. 

20 



306 PNEUMONIA AND 

over the surface of the body ? If the reader doubts it, let him open 
the works of Jenner, Gregory, 1 Andry, 2 Gardien, 3 Desormeau, 4 
Mauriceau, 5 Dimdale, 6 and other writers of easy access, and he will 
find instances of this transmission stated by high and reliable 
authorities. He will find that Mauriceau, whose celebrity as an 
obstetrician is known to all, was himself born bearing the charac- 
teristic marks of that disease. He will find, besides, that cases are 
recorded in which those well-known marks were found on infants 
whose mothers were not affected. 7 He will even find — but for 
the authenticity of the fact I will not hold myself responsible — 
that a Swedish woman having been vaccinated nine days before 
her accouchement, the child, at its birth, bore on the arms, and on 
the same spots as the mother, regular vaccine pustules. 8 Extending 
his inquiries to other complaints, he will find that measles, scarla- 
tina, syphilis, 9 and pellagra 10 are reported to have been thus trans- 
mitted. "While such is the case with these diseases, we have the 
testimony of Eussell, and others, to the effect that a similar occur- 
rence has sometimes taken place in relation to tertian and other 
malarial fevers. By more than one author cases are mentioned — 
and one of the kind fell under the notice of the present writer, 
in which some of the symptoms of yellow fever were transmitted 
in this way, from the mother to the unborn babe. 

Dr. Ludlow, in his observations on the lake fevers in the Genesee 
country, 11 relates the following case: — 

" Mrs. R. had fever and ague at two different times. During the 
last* stage of her last pregnancy intermittents were very prevalent. 
Having for several days suffered some of the precursory symptoms, 
she was, on Sunday afternoon, attacked with a severe paroxysm. 
Every stage of it was regular and distinct, the paroxysm terminating 
in diaphoresis. On Monday morning she was delivered of a boy, 
apparently at the full time. On Monday afternoon, at about the 

1 Cyclop, of Pract. Med. iii. 

2 Maladies du Foetus, Journal cles Progress des Sc. Med. N. S. i. 142. 

3 Traite des Accoucheuiens, 352. 4 Diet, de Med. xv. 

5 Observ. sur la Grossesse, &c. ii. 493 ; Obs. 1). C. 

6 Treatise on Smallpox, 279. 

7 Bousquet, Traite de la Vaccine, 167 ; Fodere', Med. Legale, v. 397 ; Jenner, Jour- 
nal des Progres, i. 142-6 ; Deneux, cited by Anglada, Traite' de la Contagion, i. 81. 

8 Journal des Progres, xv. 246. 9 Journal des Progres, i. N. S. 142, 170. 
10 Roussel, Traitd de la Pellagre. » New York Med. and Phys. J. ii. 94, 95. 



AUTUMNAL FEVERS. 307 

same time of day at which the Sunday's paroxysm had occurred, 
the child was attacked; the cold stage was severe and long; the 
skin being livid, and the child was thought to be dying. This was 
followed by the hot stage, and, in due time, by diaphoresis. The 
paroxysms continued to recur daily for about a fortnight, when 
small doses of Peruvian bark were given. The disease soon ceased; 
but, in about a week, the child had two fits more, when the bark 
again arrested it. The child is now more than two years old, is fat 
and healthy, and has had no more attacks of the fever. The disease 
did not recur in the mother after delivery. Both still reside in the 
same house, which is on aguish ground." 

Dr. Ludlow properly remarks, that this case — as others he re- 
lates — very satisfactorily proves that the disease is sometimes con- 
genital. It is " remarkable for the regular transfer of the disease 
from the mother (in whom the susceptibility had been worn out) 
to the child, who, like others who had never had the disease, was 
perfectly susceptible of it." The child was affected too soon after 
birth to justify our believing he did not carry in him the seeds of 
the disease. Dr. Stokes relates the case of a woman, pregnant and 
labouring under tertian fever, who felt the child to have convulsive 
fits on days of pyrexia. 

Boudin, to whom reference has so often been made, states that 
he has several times had occasion to notice the transmission of the 
disease in question, from nurses to infants at the breast, as manifested 
by paroxysms of fever, and other limnhenic symptoms. " In proof," 
he adds : "I will add that the infants in question were not under 
the influence of a primitive intoxication, caught by them in a focus 
of paludal exhalation, and that my observations were made at the 
Lazaretto of Marseilles, where malarial fevers, unless imported, are 
never encountered. Doubtless the most curious fact of transmis- 
sion I have met with, is the following: The wife of a soldier, 
recently arrived from Africa, and enjoying good health, undertook 
to nurse the child of an inhabitant of Toulon. On the third day, 
the child was attacked with a malarial fever, which was only cured 
by the sulphate of quinia." 1 In this respect, paludal fevers are on 
a footing with syphilis, the mercurial disease, &c, all of which are 
transmissible from a healthy nurse to the infant at the breast. 
That typhoid fever has been found to be so conveyed, is proved 

1 Fievre Interm. 193, 194. 



308 PNEUMONIA AND 

by the ulcerations discovered in the intestines of the child. 1 The 
same has been reported in reference to dysentery. 2 

The cause of autumnal fever appears to he neutralized by the poison 
of some zymotic diseases ivhich have no effect on common complaints. — 
Attention might be called also to and much said on the fact 
observed in Sweden and other parts of Europe, 3 that intermittent 
fevers disappeared for several years, after the great epidemic of 
cholera, from their usual habitats ; that the observation was made 
not only in places that had been visited by cholera, but likewise in 
localities where that disease had never appeared ; and that, after the 
decline of the former, fevers again made their appearance, but in a 
less malignant form — facts which cannot be readily explained, ex- 
cept on the supposition of the cause of fevers being of the nature 
contended for, and of its being destroyed or neutralized by the one 
giving rise to cholera. 

It is also to be borne in mind, that mephitic exhalations would 
appear to have the power of imparting protection to those accus- 
tomed to them against malarial diseases, as also against those arising 
from peculiar meteorations. It was remarked at Paris, that indi- 
viduals employed or living in the immediate vicinity of the exten- 
sive knackery of Monfaucon, did not suffer, to any serious extent, 
from the cholera, which almost decimated the other districts of that 
city. In some parts of England, the men whose business it was 
to attend to the drains were in like manner almost entirely exempt 
from that disease. 4 Kaymond, nearly a century ago, had made 
similar observations in regard to other zymotic complaints. " I no- 
tice," he says, "that workmen employed at inferior (sordides) trades, 
and in factories filled with vapours, such as starch-makers, tanners, 
buckskin-makers, &c, are less subject to popular diseases. This 
observation reminds us of one recorded by Cole cle Ballona, that 
during the fatal plague of the year 1348, individuals working at 
filthy trades escaped the contagion." 5 The reader cannot have for- 
gotten that during the fatal epidemic of yellow fever which visited 
the city of Philadelphia, in 1793, it was observed by Dr. Kush, 6 that 

1 Boudin, 196; Rcederer and Wagler, 163. 

2 Zimmerman, Traitd de la Dys. 28; J. Frank, Prax. Med. ; Watson, 440. 

3 British and Foreign Med.-Chir. Rev. x. 375. 

4 First Report of Commissioners on the State of Large Towns, 160, 164. 

5 Mem. de la Soc. Roy. de Med. iv. 77. 6 Works, iii. 83. 



AUTUMNAL FEVERS. 309 

the scavengers suffered much less than others differently employed. 
Similar statements are made by Caillot. 1 Ambrose Pare remarks 
that during the epidemic fever which prevailed at Paris in 1565, 
tanners and curriers were in great measure exempt. It may be 
remarked in addition that at Eome the section appropriated to the 
Jews, the Ghetto — where the precepts of public hygiene are sadly 
neglected, and where of course filth abounds — is not entirely but 
comparatively free from the periodic fevers which afflict severely 
other and cleaner parts of the city. 2 

It is from a consideration of these facts, and from having observed 
that in some localities in Mexico and other parts of America, indi- 
viduals inhabiting filthy districts suffer less from yellow fever than 
those who live in cleanlier ones, that a physician of our country 
maintained that what have heretofore been regarded as sources of 
infection are, on the contrary, conducive to health. Without stop- 
ping to inquire whether the exemption alluded to is not the effect 
of acclimatization or habit on the part of those who are supposed 
to have reaped advantage from the nastiness in question ; and, 
without arguing the point, whether it would be beneficial or safe 
to allow such filth to remain undisturbed with a view to counteract 
the baneful effect of the febrile poison, I may remark that the 
theory, and the practice founded upon it, are not new, as may be seen 
in the following passage I transcribe from Lancisi : 3 " Some have 
entertained a notion that the effluvia of corrupted ■ substances and 
marshy waters had no manner of noxious operation, because they 
have read that these very agents were sometimes considered as 
remedies in some pestilential seasons. Thus, Alexander Benedictus 
relates that he had heard from a merchant of Candia, that all the 
dogs were killed during the prevalence of a violent plague, and by 
order of the physicians thrown about the streets. The air was soon 
filled with their corrupting exhalations, and their remedial operation 
immediately restored the place to health. The Sarmatians were ac- 
customed to employ the same means. Yery near akin to this story 
is another, related by George Pictorius, who heard a man from 
Utopia (!) affirm that, in an epidemic plague, nothing was more 
wholesome and excellent than, three times a day, to snuff up the 

1 Op. cit. 123. 

2 Tournon, Etudes sur Rome, ii. ; Carriere, Le Climat de FItalie, 373; Valentin, 
Voy. Med. en Italie, 100. 

3 De Nox Palud. Em. lib. i. cap. iv. 11, 12. 



310 PNEUMONIA AND 

fumes of a privy or of a sheepfold. So, also, Joseph Quercetanus 
adduces the case, so familiar to the people of Paris, to wit, that of 
the nastiuess of their streets being considered by many physicians 
as checking the putrefactive taint of their atmosphere. Nor are 
there wanting other authorities from very serious writers, collected 
by Gaspar a Kejes, by which it is shown that bad smells are some- 
times valuable auxiliaries of nature." 

It is but justice to Lancisi to remark, that he attached no faith 
to the theory thus set forth, or to the advantages of the practice 
suggested, and seems disposed to unite in opinion with Eejes, who 
rejects the practice, and says that the experiments and their authors 
ought to be banished to those barbarous places where the former 
were made. 

Cause of autumnal fever antagonistic to that of some other diseases. — 
Nor is this the only instance of antagonism that may be referred to 
in illustration of the toxicological nature of the cause of malarial 
fevers. That of phthisis with such fevers, in virtue of which one 
of these diseases is stated to exclude the other, might, if founded 
in fact, be usefully adduced ; for such an antagonism could not be 
explained otherwise than on the supposition of the cause of fever 
consisting of something different from a mere modification in the 
sensible qualities of the air — of something specifically different from 
the ordinary causes of disease, and of the tubercular virus in par- 
ticular, and capable of neutralizing the latter, or of producing a 
diseased condition of solids and fluids, which exercises a counter- 
acting influence. Originally suggested in Italy, in the early part 
of the last century, by Lancisi, who found, or thought he had found, 
that " marshes are salutary to men of certain temperaments, such, 
for example, as are full of acrid salts, prone to coughing, or slender 
frames, and predisposed to consumption,'" the belief in this patho- 
genic antagonism was subsequently advocated, in 1783, by Dr. 
Bang, 2 of Copenhagen, and in 1784, by Dr. Marx, in a treatise on 
consumption. Taken up anew in England, more than half a century 
ago, by Dr. Harrison, of Horncastle, Lincolnshire, 3 and ten years 
after him, by Dr. "Wells, of London, 4 it has been revived recently 

1 Op. cit. lib. i. cap. v. 19. 2 Sebata Diarii Nosocomii Fredericiana, i. 15. 

3 London Med. and Phys. J. viii. 221, Lond. 1802. 

4 Trans, of a Soc. for the Improvement of Med. and Chirurg. Knowledge, iii. 471, 
Lond. 1812. 



AUTUMNAL FEVEES. 311 

by Dr. Boudin, 1 and by him sustained with considerable ability and 
much research, but with an evident pretension to originality well 
calculated to elicit a smile from his English and American readers. 
But although this antagonism has won the admiration of this able 
writer, and is well thought of by some of his countrymen, and a 
few physicians elsewhere; 2 although it be true that phthisical 
patients are frequently benefited by a residence in malarial locali- 
ties; that such localities are noted for the rarity or absence of 
phthisis ; that those in which the latter disease prevails are free 
from periodic fevers ; that these diseases have been found to replace 
each other in the same locality ; and that phthisis is becoming com- 
mon where the country, in consequence of the draining of marshes, 
is freed from febrile paludal diseases ; and although, besides, the 
power in question is in some measure explained and sustained 
by the circumstance pointed out by Eokitansky, that an unusual 
venosity of the blood — a condition observed in malarial fever — 
proves an obstacle to the formation of tubercles ; still, the theory 
has not yet been satisfactorily established. So far, indeed, from its 
being true that one of these diseases excludes the other, facts may 
easily be found to show that, in many regions of country where 
intermittents and remittents are common, phthisis is as frequently 
encountered as in non-malarial districts of neighbouring or distant 
latitudes ; while there are many reasons to believe that the absence 
of phthisis, and its mitigation in some paludal districts, is attributa- 
ble to the peculiarity of climate, growing out of the thermometrical 
and hygrometrical conditions of the atmosphere, rather than to any 
direct and antagonistic agency of the malarial poison there evolved. 3 

1 De l'lnfluence des localites Marecageuses sur le frequence et la marche de la Pht. 
Pulni. et de la F. typhoide An. d'Hyg. xxxiii. 58, and republished under the title of 
Etudes de Geologie Me"d. sur la Phthisis P., Paris, 1845; ibid. Tr. des F. Int. and 
Remit. 1842, p. 72 ; ibid. Essai de Geogr. MM. 42, &c. 

2 Tribe, De l'heureux Influence des localites Marecageuses sur la tuberculisation 
pulmonaire, Montpellier, 1843; Green, New York Journ. of Med. and Surg. 1840; 
Hennen, Topography of the Mediterranean, 223 ; Carriere, Du Climat de l'ltalie, 336; 
Heulard, Mem. de l'Acad. de Med. xiv. 129 ; Bulletin de FAcad. de Med. vii. 213, 305, 
viii. 931 ; Haspel, Maladies de 1' Algeria, ii. 423 ; Giannini, Delia Natura delle Febbri, 
i. 115, and i. 237 of translation; King, Southern Journ. of Med. and Surg. Sci. L 
167 ; Pritchett, African Rem. Fever, 125 (note) ; Schoenlein, Klinische Vortrsege, 
Berlin, 1842; Wilson, Stat. Reports of the Health of the Navy (British) S. Am. 111. 

3 Lefevre, Bulletin de l'Acad. x. 1041 ; Southey, Observations on Pulmonary Con- 
sumption, Lond. 1814; Forry, Climate of U. S. 265, 266; Sir J. Clark on the Sanative 
Influence of Climate, 60, 3d ed. ; An. d'Hyg. xxxvi. 8, 12 ; Grant, Sanitary Condition 



312 PNEUMONIA AND 

Dr. Lawson, in an instructive essay on the effects of climate in 
the production of diseases of the lungs, 1 states, after a thorough 
examination of the subject, that the mortality of tuberculous affec- 
tions of the lungs among the English troops, in the various mala- 
rious localities they occupy, completely accords with the opinion 
of Sir James Clark and Dr. Forry; for, although the absolute num- 
ber of deaths from these diseases may, in the malarious situations, 
be less than in a more healthy one, still, they will always be more 
numerous, relatively to those from the purely inflammatory- diseases 
of the lungs, than in the more healthy locality. It is not sure, 
indeed, that, instead of diminishing the tendency to consumption, 
malaria will not increase it ; for it seems, as we all know, to destroy 
the balance of the functions, and lessen the tone of the system, and, 
by defibrinating the blood, deprives the body of the proper nutri- 
tion by which the organic functions are sustained — circumstances 
which all tend to produce or arouse the tubercular diathesis. 

More plausible in many respects — better sustained, indeed, by 
facts, and explainable only by the neutralizing or antidotal effects 
of different poisons — is the theory of a pathogenic antagonism 
existing between the cause of malarial diseases, properly so called, 
and that of typhoid fever, by virtue of which the latter fever seldom 
if ever prevails iu paludal localities where periodic fever abounds, 
and vice versa; and in the same locality, at different periods, and 
under particular conditions of soil. Whether the history of these 
two forms of febrile complaints, in all regions they visit, will bear 
out the advocates of this antagonism to the full extent of their con- 
clusions, is more than can be now positively averred. Judging, 
however, from the many facts collected by M. Boudin, 2 who de- 
serves more credit on the score of originality, in relation to this 
point, than to that of the antagonism of phthisis with malarial 
fevers, and from others gathered in this country and elsewhere, it 
is impossible to withhold the expression of the opinion that the 
theory he has suggested is entitled to a respectful consideration. 
In the malarial districts of France, Germany, Spain, Algiers, Bone, 
Senegal, India, and Greece; in the Morea, and the Walcheren, 
typhoid fever is never or scarcely ever to be found. Nor is it less 

of Memphis (Term.), Am. J. July, 1853, p. 115; Helfft, Zeitschrift fur Gesammte 
Medicin, B. 3, s. 360, see Edin. J. lxxi. 378 ; Michel Levy, Bulletin de FAcad. viii. 
930, &c. ; Chargellay-Lagarde, Bulletin, xii. 257. 

1 Edinb. Journ. lxii. 57. 2 See the work cited above. 



AUTUMNAL FEYEES. 313 

true, that it is little known in the West Indies. On the other hand, 
in parts of Europe where typhoid fever is common, intermittents 
and remittents are rare. At Constantine, in Africa, periodic fevers 
are scarcely ever seen, while typhoid cases are numerous. In the 
city of Strasburg, typhoid fevers are common, intermittents rare. 
In the citadel, the reverse is the case. In Paris, Berlin, Dresden, 
and St. Petersburg, we find typhoid fever in abundance ; but little if 
any of the other disease. In Denmark, periodic fever drove away 
tvphoid fever, which reappeared when the former had ceased to 
prevail. In England, much the same thing has occurred ; for there, 
as elsewhere, "it has been noticed that when intermittent fever 
has yielded to improvements in cultivation, drainage, &c. typhus 
very commonly succeeds." 1 Individuals arriving from marshy 
localities, with their systems saturated with the cause of periodic 
fever, in places where typhoid fever prevails, resist for a long while 
the cause of the latter, and vice versa. (Boudin, 102.) 

In this country, much the same results are obtained. Intermit- 
tents once were common in the New England States; they have 
made way, except in a few spots, for typhoid fever, which is the 
prevailing febrile complaint of the country. In the south and west 
the typhoid is gaining ground, and replacing the periodic forms in 
districts where these once exercised an exclusive sway. Speaking 
of typhoid fever, Dr. Bartlett says : " I have often met it in Ken- 
tucky, where it is sometimes called the red-tongue fever. It is, 
probably, less common in those portions of the United States which 
are vitiated by the various forms of intermittent fever, than in those 
which are exempt from these diseases, although more extensive 
and accurate observations, than have yet been made, are necessary 
to settle this point." 2 Another distinguished writer of this country, 
Dr. Cain, of Charleston, S. C, in a report on the diseases of his 
State, remarks : " The intermittents and remittents were first ob- 
served to lapse into the continued type (typhoid), and finally gave 
place to the latter altogether. The typhoid now holds, it may be 
said, undisputed sway over Fairfield, Newbury, Chester, Union, 
Laurens, Abbeville, and Edgefield Districts, composing a portion 
of the clay -hill region of the State, but extending somewhat into 

1 Cowan (C), Report of the Reading Dispensary; Trans. Provincial Association 
(N. S.), ii. 202. 

2 Bartlett on Fevers, 2d ed. 84. 



314 PNEUMONIA AND 

the middle or sand-hill region, affecting Barnwell, Sumter, Ker- 
shaw, and Lancaster Districts." 1 

Alluding to Bedford County (Term.), Dr. Lipscombe remarks: 
"In this part of the county (the northern and western), in former 
years, intermittents, remittents, and bilious fevers were more pre- 
valent than in the more broken parts of the county. But for the 
last nine or ten years, these types of fever seem to have been gra- 
dually disappearing, and the enteric or typhoid fever to have taken 
its place." 2 Another writer, Dr. McJSTally, reporting on the dis- 
eases of Lincoln County, in the same State, says : " Until within the 
last two or three years, bilious remittent, and intermittent and con- 
gestive fevers were the principal diseases which visited this county, 
especially in the summer and fall. They were epidemic every 
year, in every part of the county. Pea Ridge was more exempt than 
any other part ; but occasionally they prevailed there as extensively 
as elsewhere. But for two years past they have been only partially 
so. During last summer and fall, they prevailed extensively in those 
portions of the county not visited by dysentery and typhoid fever? At 
Shelby ville, we are told that "the general type of disease, as 
late as about 1846, was sthenic." " Since 1845 or 6, this charac- 
teristic of disease has yielded to the opposite or asthenic form. 
Since that period, we have had more or less enteric or typhoid 
fever to contend with ; and less and less of the old-fashioned bilious, 
remittent, and intermittent." 4 * 

In Alabama, as we are told by Drs. English 5 and Anderson, 6 the 
same observation has been made. By the former, it is remarked 
that typhoid fever has pretty nearly superseded the remittent and 
congestive fevers that once prevailed in that State ; and the latter 
writer, speaking of the diseases of South Alabama, states that 
autumnal fevers have totally declined there of late years, and that 
typhoid — a case of which was never heard of till within the last 
five years — has become a stranger among the inhabitants of this 
country. Indeed, as observed by Professor Dickson, 7 in "all the 

1 Trans. Am. Med. Assoc, v. 358. 2 Ibid. vi. 321. 

3 Ibid. 4 Ihid% 327, 328. 

5 N. 0. Med. and Surg. Journ. vi. 168. 

6 Prize Essay on the Summer and Autumnal Fevers of South Alabama. Transl. of 
Med. Soc. of the State of Alabama, for 1852. 

7 Report on the Blending of the Types of Fever; Trans, of the Am. Med. Associa- 
tion, v. 155 ; Charleston Med. Journ. vii. 843. 



AUTUMNAL FEVERS. 315 

southern medical journals, of recent date, we find it stated that 
throughout our malarial middle country — and, indeed, though less 
strikingly, in our lower alluvial districts also — typhoid fevers are 
becoming more and more frequent in places and settlements, and 
under circumstances, where, hitherto, the ordinary autumnal remit- 
tents and intermittents prevailed exclusively. In certain localities, 
the congestive forms of intermittents and remittents seemed for 
years past to be gaining ground, but now appear to be giving way, 
in their turn, to this newly observed type." It may be proper to 
remark, that the probability of this conversion or substitution had 
not escaped the prophetic eye of our great medical philosopher, the 
late Dr. Drake, who thought it likely that autumnal fevers would 
decrease, and typhus and typhoid fevers become more prevalent, 
throughout the whole Valley of the Mississippi. 

Doubtless, it is not to be denied that typhoid fever is found 
occasionally to prevail in malarial districts conjointly with periodic 
fevers. Eamel 1 described the combination long ago, as having fallen 
under his observation in some parts of the coast of Barbary and 
Provence, where intermittents were and are still of common occur- 
rence. It is also found in La Vendee, in Brittany, in sundry valleys 
near Paris, and other malarial parts of France, where periodic fevers 
are matters of annual observation. In this country, too, it is on the 
increase, or already prevails extensively in some aguish or fever 
localities, as at Memphis, for example, where fevers attributable to 
malaria have not yet, notwithstanding the appearance of the intruder, 
lessened in frequency. 2 It may be true, also, that one of the main 
reasons of typhoid fever being in general less common in rural dis- 
tricts than in cities, as also in the marshes of Corsica, Languedoc, 
Italy, Algeria, and this country, is to be sought in the sparseness of 
the population, and in the absence of other morbific agencies which 
are found in denser communities, and are known to lend a powerful 
aid to the production and propagation of the disease ; while the 
causes of periodic fevers, which are not found in the latter localities, 
have not been removed in the former, and continue, therefore, to 
exercise there their baneful influence. 3 But on the latter point 

1 Memoire sur l'Influence des Marais, &c. sur le Sante de l'liomnie. Marseilles, 
an. x. 

2 Grant, Sanitary Condition of Memphis, Am. J. July, 1853, p. 103. 

3 La Pilcur, Quelques Objections a la Theorie de l'Antagonisme, An. d'Hygiene, 
xxxvi. G, 7. 



316 PNEUMONIA AND 

we have nothing but conjectures, which are met by the fact that 
typhoid fever exists now paramount, and is becoming a source of 
terror in many rural districts, where the population is nearly as 
sparse now as it was previous to its appearance and the decline of 
its antagonist, and where the other morbid agents above referred 
to do not exist more abundantly now than they did during the 
reign of the latter disease. Be this as it may, examples of coexist- 
ence are not as frequent as those of reciprocal exclusion ; and if they 
were, would not form a valid objection to the doctrine of antago- 
nism, as we can have no reason to deny the possibility of the occa- 
sional existence, at the same time, of the two poisons. 

On these various topics much more, I am aware, might be said. 
I might appeal also to the phenomenon of incubation, and show that 
the seeds of autumnal fever, like those of other zymotic diseases, 
occasionally remain concealed in the system during more or less 
time until brought into activity through the operation of some 
exciting agent — often, under circumstances which prevent all idea 
of attributing them solely to the action of the causes to which they 
are ascribed by the opponents of malaria. Let individuals so 
situated — who have been exposed to the influence of the febrific 
cause in some sickly place — remove to a salubrious district, where 
remittent, intermittent, and yellow fevers are not known, and they 
will not unfrequently be attacked with one of these diseases weeks or 
months after their arrival, in consequence of exposure to the action 
of the sun, to sudden transition from heat to cold, to a shower of 
rain, or to any other influence by which the surface is chilled after 
being heated, and perspiration checked ; or after a fit of intempe- 
rance. Cases of this kind, as we shall see in a future chapter, are 
not unfrequent. Can we admit that here we are furnished with an 
illustration of the production of the fever by some sudden change 
in the sensible qualities of the atmosphere, and independently of 
the agency of a febrific poison? Had atmospheric vicissitudes, and 
the other morbific agencies referred to, acted otherwise than as 
mere exciting causes, we should have had as their product a disease 
commonly occasioned by them in the locality where the attack has 
taken place, and not a variety of fever unknown there, but similar 
to that prevailing at the place whence those individuals came. 

Let us notice another occurrence. Two bodies of men arrive in 
a salubrious locality, the one from a place where typhoid fever pre- 
vails, the other where periodic fevers reign. For months, the first 



AUTUMNAL FEVERS. 317 

body remain subject to typhoid fever, and are not troubled with 
intermittents. As regards the other set, intermittents continue to 
prevail among them, while they are entirely free from typhoid. If 
so attacked, weeks or months after exposure to sickly localities, by 
fevers in every way similar to those they have left behind, but un- 
like the diseases existing in their new place of sojourn, it is evident 
they must have carried within their system the seeds of such fevers ; 
— those from typhoid districts the seeds of typhoid fever, those from 
malarial districts the seeds of periodic fever. They are not indebted 
for the disease by which they are there seized to any morbific agent 
existing in the place of attack, for nothing of the kind is there to 
be found. It is the result of exposure elsewhere. Such being the 
case, the seeds they have thus carried with them, and which are at 
last called into action, must be of a specific toxical character, for 
none but morbid poisons can remain long latent in the system; 
and the atmospheric vicissitudes, through the instrumentality of 
which the attack may probably have been brought about, cannot 
have acted otherwise than as a merely exciting agent, seeing, par- 
ticularly, that other morbific influences, a fit of intemperance, a 
burst of passion, &c, produce at times the same effect. 

I might dwell on the circumstance that as, in the above instances, 
the cause of the febrile attacks under which the individuals alluded 
to suffered were evidently of the kind mentioned, and not atmo- 
spheric vicissitudes or simple insolation, it would be unphilosophi- 
cal to attribute the same disease to these latter agencies alone, and 
ignore the aid of the malarial poison under consideration. I 
might farther dwell on the process of acclimatization, and draw 
from what we know on the subject an argument in favour of the 
doctrine of the toxical nature of the febrile cause. Again, I might 
point out, in support of the same doctrine, that in some forms 
of autumnal or malarial fever, individuals who have once passed 
through the disease, are like those who have suffered from some 
other zymotic diseases, and, perfectly unlike anything that takes 
place in complaints arising from heat, moisture, or atmospheric 
vicissitudes, free from a second attack. But on some of those 
circumstances, no additional illustration can be required ; and, as I 
shall have occasion to revert somewhat in detail to the others in a 
future chapter, I must here drop the subject. 

As already remarked, enough has been said to show that au- 
tumnal fevers depend for their generation on something exhaled 



318 PNEUMONIA AND 

under the influence of certain thermometrical and hygro metrical 
conditions of the atmosphere, from the soil or the substances accu- 
mulated on its surface. Whatever may be our predilections, or 
even our convictions, relative to the nature of the substance thus 
produced — and the reader cannot have failed to perceive that, on 
that score, my opinions are already formed — it matters not, strictly 
speaking, to the question more particularly under consideration, 
whether it consists of animalcules, of fungi, of a gaseous or vapor- 
ous poison, or whether it must be viewed as a vegetable, or animal, 
or vegeto-animal product. Nor is it necessary, in order to sustain 
the position assumed, that I should prove, any more than has been 
done already, that the poison is the result of the decomposition, 
fermentation, or putrefaction of organic matter, or of any other 
known substance; or, that I should establish beyond controversy 
that it is independent or not of those processes, and the result of 
some unknown and mysterious agency operating in some equally 
mysterious manner, or some unascertained materials floating in the 
atmosphere, but having a predilection for particular localities. 

On the animalcular doctrine, as applied to malarial fevers, and 
other zymotic diseases, we may allow its modern advocates, both 
those who regard it established beyond the reach of doubt, and 
those who consider it as most plausible — Bradley, 1 Pleniz, 2 Gattoni, 3 
Crawford, 4 Mojon, 5 S.Brown, 6 Holland, 7 Drake, 8 Wood, 9 Grognier, 10 
Nott, 11 Grassi, 12 Easori, 13 and Milroy, 14 to repeat much that was said 
in former days by Yarro, Lucretius, Columella, Vitruvius, Kircher, 
Yalisnieri, Lancisi, Linnaeus, Nyander, Ricia, Hartsaeker, MoufHet. 
The same liberty may be extended to the defenders of the doctrine 

1 The Plague of Marseilles considered, 1730. 

2 Op. Med. Phys. 1762. 3 Mem. de la Soc. de Me'd. x. 104. 

4 Remarks on Quarantines in Baltimore, Observer, April and August, 1807. 

5 Interno alia natura del Miasmo Choleroso Asiatico, Lucca, 1882. A French 
translation of this clever essay, by Julia cle Fontanelle, was published at Paris in 
1832. See Rev. of it in the N. A. Med. and Surg. J. 

6 Dissertation on Bil. Malign. Fever, Boston, 1797, p. 9. 

7 On the Hypothesis of Insect Life, in Med. Notes, chap, xxxiv. Am. Ed. 

8 A Practical Treatise, &c. on Epid. Cholera, 34, 41 ; Topogr. and Dis. of the Val- 
ley of Mississippi, i. 723. 

9 Practice of Medicine, i. 147, 306. 

10 Archive de Statistique du Dept. du Rhone. 

11 New Orleans Med. and Surg. J. iv. 563. 

12 Rapport a l'Acad. Roy de Mdd. sur la Peste (Pieces et Doc.) 418. 

13 Ibid. I4 Quarantine and the Plague, &c. 11. 



AUTUMNAL FEVERS. 319 

which ascribes febrile epidemics, as well, indeed, *as cholera and other 
zymotic diseases, to the toxical effects of various fungi — Pliny, 1 
Varro, 2 Ovid, 3 Keinesius, 4 Kamazzini, 5 Lange, 6 Paulet, 7 Hecker, 8 
Henle, 9 Cawdell, 10 Mitchell. 11 Either of these doctrines may, if they 
suit the fancy of their advocates, be adopted. Either, separately con- 
sidered, or both conjoined, may, for what I know to the contrary, be 
founded on fact and solid reasoning; though, judging from experi- 
ments recently adduced by a distinguished authority, Prof. Leidy, 12 
I have strong misgivings on the subject. 13 We may leave the che- 

1 Bk. xviii. chap. xxix. 2 De Re Rustica, lib. i. cap. 12. 

3 Fast. lib. iv. v. 907. 4 P. 218. 

5 Const. Epid. Martinensis, anni 1690, i. 3, 4. 

6 Quoted by Dr. J. K. Mitchell, 38. 

7 Rech. Hist, et Phy. sur les Maladies Epid. 443. 

8 On Epid. of the Middle Ages, 206. 

9 Pathologische Untersuehungen, 15 ; Brit, and For. Med. Rev. ix. 398. 

10 A Disquisition on Pestil. Choi. Lond. 1848. 

11 On the Cryptogamous Orig. of Malarious Dis., Philad. 1849. 

12 Flora and Fauna within Living Animals, Introd. 14, 15. 

13 "Many important diseases have been supposed to originate from parasitic ani- 
mals and vegetables. The former are not the true entozoa ; for these are too large, 
and may be detected by the naked eye ; but they are to be considered to be animal- 
cules, so small that they cannot be discerned even with the highest powers of the micro- 
scope. But, independent of the fact that the existence of such entities is a mere 
suspicion, none of the known animalculse are poisonous. At various times, I have 
purposely swallowed large draughts of water containing myriads of Monas, Vibrio, 
Euglenia, Volvox, Leucophrys, Paramecium, Vorticella, and without ever having per- 
ceived any subsequent effect. 

" The production of certain diseases, however, through the agency of entophyta, is 
no longer a subject of doubt, as in the case of the Muscardine in the silkworm, the 
Mycoderm of Porrigo favosa in man, &c. But that malarial and epidemic fevers have 
their origin in cryptogamic vegetables or spores, requires yet a single proof. If such 
were the case, these minute vegetables and spores, conveyed through the air, and 
introduced into the body in respiration, could be detected. The minutest of all 
known living beings is the vibrio lineola of Muller, measuring only the 36,000th of an 
inch ; and the smallest known vegetable spore is very much larger than this, whilst 
particles of inorganic matter can be distinguished the 200,000th of an inch in size. 

" I have frequently examined the rains and dews of localities in which intermittents 
were epidemic upon the Schuylkill and Susquehanna Rivers, but without being able 
to detect animalculoe, spores, or even any solid particles whatever. I have examined 
the air itself for such bodies by passing a current through clear water. This was 
done by means of a bottle with two tubes passing through a cork stopper ; one tube 
dipping into the water, the other reaching not quite to its surface. By sucking upon 
the latter tube, a current of air passed through the former, and was deprived in its 
course of any solid particles. Ordinarily, when the atmosphere was still, early in the 
morning, or in the evening, neither spores nor animalcules could be detected. When 



320 PNEUMONIA AND 

mists to discuss the* claims of the various gases to the distinction of 
producing the morbid effects in question. We may grant, if per- 
chance any one insist upon it, that Sylvius de la Boe had good 
reason for believing that the cause of fevers is of a saline and sul- 
phurous nature ; or that it is acid, as maintained by Ramazzini; or 
that it consists in an oxide of azote, as believed by Textoris. We 
may allow Dr. Balme to plead the cause of his septon of oxygenated 
azote, a substance not very different from that which, under the 
same name of septon, enjoyed some celebrity on this side of the 
Atlantic under the fostering care of our distinguished countryman, 
the late Dr. S. L. Mitchell, of New York. We may also allow Pro- 
fessor Dunglison to write and teach that vegetable matter has 
nothing to do in the production of the morbific agent. We may, 
besides, offer no objections to the opinion of Dr. Warren, and others, 
who are no less zealous in absolving animal matter from all blame 
in reference to the effects in question ; and we may go so far, for the 
sake of argument, as to admit, if hard pressed by some fastidious 
disputant, that the cause is not the production of the decomposition 
of any kind of organic matter. All I insist upon at present is, that 
be its nature, the materials from which it is derived, and the pro- 
cess by which it is generated, what they may, the febrile poison is 
a stranger to, and must not be confounded with, the natural and 
unchangeable constituent elements of the atmosphere; that it is 
distinct from, and independent of, mere modifications in the sensi- 
ble qualities of the latter ; that it is suspended and floats in it, and 
is wafted by the wind ; that it possesses an individuality of its own, 
and serves, by its poisonous properties, to render the air of locali- 
ties where it is generated or conveyed insalubrious, and a fruitful 
source of fever. 

Other objections urged against the malarial origin of periodic or 
autumnal fevers. — It can scarcely be necessary to occupy our time 

piles of decaying sticks, or dry leaves were stirred up, or the dust was blown about 
by the wind, a host of most incongruous objects could be obtained from the air; none, 
however, which could be supposed capable of producing disease. To assert, under the 
circumstances, that there are spores and animal culos capable of giving rise to epidemics, 
but not discernible by any means at our command, is absurd ; as it is only saying, in 
other words, that such spores and animalcule are liquid and dissolved in the air, or 
in a condition of chemical solution." (Lcidy, Flora and Fauna within Living Animals, 
Introduction, 14, 15.) 



AUTUMNAL FEVERS. 321 

in examining in detail the value of various other objections urged 
against the existence and febriflc power of malarial exhalations. 

It is not likely that those who believe in the morbific agency 
of these, and recognize in them the essential or efficient cause 
of autumnal fevers, will be disquieted by the reasons assigned in 
opposition by Giannini 1 and others, who remark that the exist- 
ence of malaria may be disproved on the following grounds : 1. 
When a morbific matter is introduced into the human body, it 
manifests its presence by the occurrence of cutaneous eruptions 
and spots — phenomena which are never observed in malarial or 
periodic fevers. 2. The morbific matter, when introduced, is usu- 
ally expelled by means of critical discharges, more particularly by 
sweats. This evacuation, in intermittent fever, is an effect of the 
hot stage, and not an expulsive effort to get rid of the miasm. 
Thus, when this last-mentioned stage is arrested by means of cold 
immersions, the sweating process does not take place. 3. Morbific 
matters, inimical to the organism, when introduced into the body, or 
simply applied to the surface, usually manifest the power of repro- 
duction and multiplication. Through means of this power, a similar 
disease is reproduced in those who come in contact with the sick. 
Nothing of the kind takes place in intermittent fever, which pro- 
duces no morbific matter or excretion, and is not, therefore, con- 
tagious. 4. Periodic fevers, which are generally thought to be 
produced by the paludal miasm, often terminate after the first 
paroxysm. If the disease arose from the miasm, it is difficult to 
comprehend how, in so short a time, that cause could be expelled, 
considering that all morbific matters that produce fever in the 
living system, remain in it some days before being expelled. 
Peruvian bark and cold affusions cannot be supposed to act in 
these cases by neutralizing the alleged poison, inasmuch as the 
same means produce the same curative effects in periodic fevers 
arising from other and totally different causes. 5. Diseases pro- 
duced by foreign matters introduced into the system are all com- 
municable by contact. So far from being the vehicle of contagious 
diseases, the atmosphere decomposes all contagions. Reasoning 
from analogy, therefore, we may conclude that the atmosphere 
would do the same as regards the alleged miasm, did it exist. 6. If 
there existed a paludal miasm, its effect would be specific and uni- 

' Vol. i. 230, 231. 

21 



322 PNEUMONIA AND 

form. So far from this, the effect of the pretended miasm is multi- 
form. It gives rise, not only to periodic fevers, but also to cachexia, 
marasmus, abdominal obstructions, dyspepsia, chlorosis, dropsy, &c. 
7. The cause often operates too suddenly to allow us to believe that 
it consists in a miasm. If such were the case, we should be led to 
admit that in a few hours the miasm has been introduced, that it 
has circulated in the lymphatic vessels, and next in the arteries 
and veins ; or that, after having penetrated the lungs, in opposition 
to the known fact that these organs receive no other gases than 
oxygen, it has been able to exercise an action on the nerves — a 
result which does not obtain in diseases produced by morbific 
agents of a poisonous character. Besides, the same effect may be 
produced by any other cause, since it is proved that an attack of 
intermittent fever is often brought on by simply sleeping one night 
in the open air in places free from marshes. Now, as in instances 
of this kind, we cannot refer the disease to any other influence 
than that of cold on the nervous system, we need not attribute the 
other phenomena to a different cause. 

To these objections it may be remarked : 1. That all morbific 
poisons, introduced into the system, do not manifest their presence 
therein by cutaneous eruptions and spots ; as proved by that pro- 
ducing hooping-cough. 2. Diseases caused by such poisons ter- 
minate often without the occurrence of critical discharges — that by 
sweat particularly — while, on the other hand, autumnal fevers, of 
the remittent or continued kind, which belong to the same class with 
intermittents, are frequently judged by such discharges. 3. Nothing 
has as yet been said calculated to prove the contagious character of 
cholera; the origin of which, from a morbific agent introduced into 
the system, admits of no doubt. Many poisonous animal matters, 
when introduced under the skin, cause dangerous and even deadly 
diseases of a specific kind, without imparting to the system the power 
of reproducing a similar matter endowed with poisonous qualities. 
4. The care of an intermittent fever by cinchona, after the first 
paroxysm, is no proof of the non-existence of a malarial poison ; 
as' there is no reason for disbelieving the possibility of a disease 
being produced by a small portion of miasmal poison, terminating 
with or without a critical discharge, in a short space of time. 
Some poisons require for their elimination a certain and fixed 
number of days ; but it does not follow that in all the duration 
must always be prolonged. Besides, in some fevers, due to the 



AUTUMNAL FEVERS. 323 

same causes, or to influences closely allied to them, the disease runs 
a long and definite course ; and, when established, is not arrested 
by the means mentioned. If arrested by cinchona, the effect is 
due, as is also the cure of intermittent fever, to the control exer- 
cised by this remedy, and some other therapeutic agents, over all 
affections that assume the periodic type, whether those affections 
be produced by one set of causes or another. Giannini himself, 
admits that typhus, petechial, pestilential, and other forms of fever, 
which he regards as the effect of morbific poisons, may be, and 
often are cut short, or greatly abridged in their duration, by cold 
immersions. 5. It is not correct to say that the atmosphere is never 
the vehicle of contagions ; since exposure to smallpox or like com- 
plaints, without contact, is generally followed, in unprotected indi- 
viduals, by an attack of the disease. The poison, in these cases, is 
certainly conveyed from the sick to the well through the medium of 
the atmosphere ; and if the latter does not always decompose it, 
immediately on its escape from the diseased body, there is no reason 
to deny that it may fail to do so in regard to the malaria producing 
periodic fevers. 6. The diseases produced by malaria are specific 
and uniform — each variety of the poison producing a different form 
of fever. The affections enumerated in proof of the multiform effect 
of marsh poison are only sequelae of the specific disease, or the 
result of the gradual and long-continued action of the cause. 7. 
And lastly, even if it were true that no other gas than oxygen 
found entrance into the lungs — which is far from being the case — 
the occurrence of fever after slight and momentary exposure to 
marsh air, is no proof of the non-existence of miasm ; for the small- 
pox and other diseases depending on morbific matters introduced 
into the system, have often been occasioned by a few moments' ex- 
posure to individuals labouring under them. 

To only one more objection shall I devote a few remarks. It has 
been said, as a proof of defective and erroneous reasoning on the part 
of the advocates of the mode of origin of autumnal fevers under con- 
sideration, and as an evidence of a culpable violation of the rules of 
induction, that such individuals insist that the same cause — not known 
even to exist at all — may and does produce different and distinct dis- 
eases in different individuals exposed under the same circumstances. 
Now, to this I have only to say, that I cannot at this moment recall 
to mind a single writer of sane intellect, or whose opinion is worth 
notice, who has ventured and pertinaciously insisted on such an. 



324 PNEUMONIA AND 

assertion. That some have believed, and continue to believe, that 
the same cause — miasmata — produces what other pathologists regard 
as different and distinct forms of fever, is perfectly well known. 
But such writers, themselves, while believing in the identity of the 
cause, believe also in the identity of all the fevers in question ; 
holding these to differ from each other in nothing but the degree 
of their violence, the organs that may be implicated, and other 
circumstances of like import. Hence the remark cannot apply to 
them. By others, nothing of the sort, so far as I can find, has been 
advanced. By them, it has doubtless been said, very correctly, as 
I think, that miasmata or exhalations produce different forms of 
fever ; but while doing so, they have not wished to be understood 
as maintaining that those exhalations are always identically the 
same in their nature. So far from this, they think themselves 
justified in the belief that, considering the great diversity of effects 
produced, as evinced by the phenomena and anatomical characters 
noticed in those several forms of fever, poisons exhaled from 
various sources of infection differ materially in composition and 
nature. The exhalations from our wharves, from the timber Of 
ships, and some other sources, produce yellow fever, and never 
intermittent fever. Those from swamps, marshes, &c, give rise to 
periodic fevers of different grades — never to yellow fever properly 
so called. In Paris, and other parts of France and Europe, and in 
various sections of our country, some effluvia appear to give rise 
to typhoid fever. In several localities of Ireland, Scotland, and 
England, certain exhalations have occasioned a peculiar form of 
fever, which, from one of its noted characteristics, has been deno- 
minated the relapsing fever. The morbus Hungaricus, of some 
centuries past, bore but a feeble resemblance to the Athenian 
plague, described by Thucydides; to the Oriental plague of the 
present day ; to the sweating sickness, and to the black death of the 
14th century ; or, again, to the typhoid fever of Paris, the typhus of 
London, or the typhoid remittent of our negro alleys ; while none 
of them resemble exactly the true yellow fever. Whatever view 
we may take of the contagious character of typhus, it is not to be 
denied that it arises often from miasmatic exhalations of some sort. 
Even among fevers that are strictly speaking of malarial origin, 
some difference occurs in their symptomatological and other cha- 
racters. The jungle fever of India is not exactly the same in form 
as the remittent of Africa: the fever of Batavia differs in some 



AUTUMNAL FEVERS. 325 

respects from the bilious remittent of this country, or of the Gambia. 
The febrile diseases of Kome are not precisely similar to those of 
the West Indies or Batavia ; and the Walcheren fever differs in like 
manner from both of these, or from that of Breskau. In France, 
the fevers of Eochefort do not present the very same characters as 
those of Bresse or of the plain of Forez. 

The Mediterranean remittent, described by Sir "William Burnett, 
is somewhat unlike the periodic fevers of England and of northern 
Europe. It differs in some particulars from that of Greece, an 
account of which is found in the justly celebrated books of Epi- 
demics of Hippocrates, or of Algeria, or the Morea. Our negro 
fever of 1822, and the Bunker Street fever of New York, were too 
unlike yellow fever on the one hand, and common periodic fever 
on the other, to be supposed to have arisen from the agency of 
precisely the same poison as these. 

This probable diversity in the nature and composition of the 
miasms in question, as exhibited by the diversity of the febrile 
phenomena they produce, has called the attention, and met with the 
assent of many writers of former and present times. It is referred 
to by Lancisi; 1 approved of by Eochoux, 2 Ferrus, 3 Desland, 4 Littre', 5 
and many others of equal note ; and particularly insisted upon by 
Twining, 6 J. M. Smith, 7 and Monfalcon. 8 

Those fevers, though bearing a close family resemblance to each 
other, are all more or less different in their phenomena, mode of 
progression, and anatomical characters, but yet are all avowedly 
the offspring of miasmal effluvia. Here, the cause giving rise to 
each form, though included with others under the generic name of 
miasma or malaria, is also regarded as different in its composition 
or in the proportion of its component parts. This is what is 
affirmed ; and not the absurdity sometimes charged on the advocates 
of the malarial origin of fevers, that a cause identically the same 
may and does produce different and distinct diseases in individuals 
exposed to it under the same circumstances. Individuals exposed 

1 Op. cit. cap. xi. 34-36. 

2 Recherches sur les Differentes Maladies, &c. 135. 

8 Diet, de Medecine, 1st ed. viii. 68. 4 Diet, de Med. Pratique, vii. 73. 

5 (Euvres d'Hippocrates, ii. 578. 6 Diseases of Bengal, ii. 288. 

7 On Epidemics, 48, 67, &c. 

8 Op. cit. 65, 69. See also Rev. of Deveze, Med. Repos. xxi. 187 ; Forry, op. cit. 
285, 291 ; Desportes, Bulletin de l'Acad. v. 380. 



326 PNEUMONIA AND 

to the same cause, under the same circumstances, will have the 
same disease. If the diseases produced differ, the cause must be 
different too; because the same morbific agents cannot occasion 
different effects, any more than different agents can occasion the 
same effect. 1 

If the causes of those diseases were precisely the same, and the 
latter consequently of similar nature, they would be convertible 
into each other, and show themselves in the same place ; yellow, 
or typhoid, or relapsing fever would, under particular circum- 
stances, be converted into a remittent or intermittent fever, and 
vice versa; and, where the one form of febrile complaints exists, the 
other forms would appear too. But, notwithstanding all that may 
be said to the contrary, experience shows that such is not the case ; 
a true yellow fever has never been converted into a typhoid or an 
intermittent fever. They may, and do often mix or combine 
together ; their types may blend, but they remain independent of 
each other, as will be dwelt upon on some other occasion. Where 
intermittent fever prevails, yellow fever frequently never shows 
itself; and in places most visited by yellow fever, the other is never 
or very seldom seen. 

In the Islands of Dominica, Demerara, and St. Lucia, common 
miasmal fevers prevail annually, while the yellow fever appears at 
irregular intervals. In Barbadoes, on the contrary, the latter dis- 
ease is of frequent occurrence, and the former scarcely known. 
Bilious remittent fever, in its worst forms, is as prevalent in India, 
in Eastern Europe, and in all parts of Africa, as in our Southern 
States, the West Indies, and the western coast of Africa ; yet, not- 

1 Cases are not wanting to show that the same locality will, under particular 
hygienic and atmospheric conditions, produce different forms of fever. Witness the 
following : At a short distance from Drieuze, in France, is situated a large pond called 
Lindre Basse, which, for special purposes, is made to undergo certain changes. It is 
two years full and one year empty. The first year it is only half-filled — the second 
year quite so ; and the third, after the fish have been taken out, it is dried and cul- 
tivated. During the first year, intermittents prevail ; during the second, typhoid 
fevers take the place of these, while during the third, malignant carbuncular diseases 
succeed to both. 1 This order of succession has been regularly observed during the 
last twenty years. 2 



1 Ancelon, Memoires sur les Fiovres Typhoides periodiquement developpees par lee 6manations de 
l'Etang de Lindre Basse. Nancy, 1847 ; Melier, Mem. de l'Aeadeniie de Med. xiii. 657. 

2 A change in the rotation in 184.8-4?, has altered the order of succession of these diseases. — Comptes 
Rcndus, 1850. 



AUTUMNAL FEVEKS. 327 

withstanding, the yellow fever is seldom if ever seen there ; while 
it is very common in the others. Bilious remittents and intermit- 
tents prevail as extensively, and with as much violence, in the 
interior of unhealthy countries as near the sea ; the yellow fever, 
on the contrary, is confined within narrow limits, and is generally 
observed on the sea-coast, and along navigable streams, and never 
extends far into the interior. The yellow fever, as we have seen, 
has often been known to arise from the foul exhalations of ships ; 
no instance, so far as I have been able to ascertain, has as yet 
occurred of epidemics of remittent or intermittent fevers having 
broken out at sea, or been traced to the decayed timber, or dirty 
bilge- water, or fermenting cargo of a ship. If they break out there, 
they have invariably been brought from elsewhere. The yellow 
fever is, strictly speaking, a disease of cities, or of places containing 
a dense population. That it has sometimes attacked small towns, 
villages, plantations, or rural districts, is true; but such instances 
are rare, and have always occurred along large watercourses. The 
bilious remittents or intermittents, though occasionally seen in city 
localities, prevail more generally in the suburbs or adjacent coun- 
try, to which the other never extends. Although it often happens 
that an epidemic of yellow fever is accompanied with a like preva- 
lence of remittents and intermittents in the surrounding country, 
or, perchance, in the infected place itself, the occurrence is not 
constant ; for instances are found when, during severe visitations, 
the country or suburbs have remained free from common malarial 
fevers. On the other hand, in some very unhealthy seasons, both 
in the West Indies and in our Southern and Middle States, when 
the fevers have prevailed most extensively, the yellow fever has 
not made its appearance. 

To those who reject these views as unphilosophical and absurd, 
it may be asked whether they are more so than others to which 
they are forced to give their assent, respecting phenomena wit- 
nessed every day. Take the process of putrefaction, as an example. 
All animal substances give by this process the same products, but 
they do not follow exactly the same laws, and present the same 
phenomena. These are often dependent on a difference in the 
proportion and nature of their constituent principles. Fourcroy, 
a high authority on this subject, remarks : " Each substance has its 
particular mode of comporting itself while undergoing the putrefy- 



328 PNEUMONIA AND 

ing process." Each gives out a particular odour, and each pro- 
duces a somewhat different effect by its action on living beings. 1 

But we ask for proofs, not assertions, and unsupported denials; 
and say, to all who condemn a doctrine which we regard as resting 
on the most solid foundations, and which, as every one must ac- 
knowledge, has received the sanction of the highest professional 
authorities, and enumerates among its advocates the larger number 
of medical inquirers, that, to succeed in their efforts, something 
more will be required at their hands, than the mere assertion that 
those who advocate that doctrine labour under a most egregious and 
unpardonable error, and are neither more nor less than open to 
the charge of hazarding a sheer hypothesis at complete variance 
with the results of daily observation and the commonest principles 
of a sound philosophy, and worthy only of those unenlightened 
minds who have lagged behind during the onward march of scien- 
tific knowledge. As for myself, whether it be from obtuseness of 
intellect, ignorance of important facts, or other circumstances of like 
import, matters not; but I cannot help thinking that, notwithstanding 
all that may be affirmed to the contrary, the doctrine of malaria is, 
to say the least, entitled to our most respectful consideration ; that 
enough has been adduced to satisfy the minds of ordinary inquirers, 
that those who admit the claims of that doctrine to be so viewed, 
are not far from the truth; that nothing, at least, has so far been 
done or said to prove the contrary ; and that the opponents of the 
malarial origin of autumnal fevers would confer an inestimable 
service on the profession, if, instead of contenting themselves, as 
they have but too generally done, with summarily disposing of the 
subject with a few words of contemptuous denial, or dwelling on 
morbific influences, not one of which can, unaided by a more effi- 
cient cause, produce any form of that disease, they were at once to 
refute all that has been said in support of that origin ; to show, 
clearly and positively, how and in what manner their opponents 
have erred and continue to err ; and to furnish us, in detail, with 
facts and arguments as numerous and strong as those they seek 
to overthrow. 

In the meanwhile, at the risk of incurring the charge of repeti- 
tion, I must, before concluding the subject of malaria, lay down 
a few propositions, which, it appears to me, we are warranted in 

1 Julia de Fontenello, op: cit. 116. 



AUTUMNAL FEVERS. 329 

drawing from a survey of all the facts and statements which have 
been passed in review. 

1. The doctrine of malaria, though of ancient origin, and very 
generally admitted, has encountered, and continues to encounter 
opposition. 

2. The appearance of autumnal or periodic fevers, where there 
are no marshes, properly speaking, does not disprove the existence 
or agency of malaria in the production of that class of disease, inas- 
much as there is nothing to hinder morbid exhalations from being 
furnished by terrestrial surfaces of a different character, and no 
writer of any reputation has denied the fact of such occurrences. 

3. The constant association of these fevers with peculiar cha- 
racters and conditions of localities, and their absence or cessa- 
tion where these characters and conditions do not exist, or, having 
existed, have ceased to do so, through the operation of artificial or 
other means, lead to the opinion of the evolvement from those 
localities of some peculiar morbific poisonous substance from the 
soil, or the materials by which it is covered ; and of the connection, 
as cause and effect, between this exhaled substance and the diseases 
in question. 

4. The inability of the chemist to detect this malarial poison in 
the atmosphere of sickly localities, and to point out its nature, does 
not disprove its existence, inasmuch as other substances, the pre- 
sence of which cannot be doubted, equally escape detection. 

5. Atmospheric heat alone will not serve to account for the pro- 
duction of periodic fevers, of various grades and types; for these 
fail to appear in seasons when, and in localities where, the ther- 
mometer ranges higher than at other seasons when, and in places 
where, they prevail extensively. Besides, instances are not rare 
when fevers have stopped, though the heat continued unchanged, 
and apparently from the influence of a very high range of tempe- 
rature. 

6. Nor can terrestrial or visible atmospheric humidity account 
alone for the effect under consideration. Though fevers often break 
out or prevail during wet weather, they usually cease when this 
humidity is at its height, and reign most generalty during the dry- 
ing process — often during very dry spells of weather. 

7. Fevers of the kind mentioned cannot be due simply to a high 
dew-point, for they exist and are rife when the latter is not higher 
than in healthy seasons. 



330 PNEUMONIA AND 

8. For reasons assigned, the efficient cause of fever cannot be 
sought in any peculiar modification in the electrical state of the 
atmosphere. This fluid, by its excess or deficiency, may and does 
no doubt exercise an agency in the matter ; but that agency is 
evidently limited to placing the system in a proper condition to 
receive the impress of a morbific cause ; to furthering, when defi- 
cient, the formation of the latter, or, when in excess, to neutralizing 
or destroying its effects. But, in all cases, the presence of such a 
cause is required, before autumnal fevers can be produced. 

9. The same may be said of atmospheric vicissitudes. These 
may and do often occur, without periodic fevers being the conse- 
quence; and, conversely, those fevers frequently occur without ap- 
preciable vicissitudes. 

10. The attack comes on too suddenly, and, not unfrequently, 
after too transient an exposure to evident sources of infection, 
without the possible concurrence of any other influencing agency ; 
at other times, it occurs too long after a residence in, or visit to 
places where the disease is known to prevail, to be the effect of any 
other cause than a morbid poison introduced into the system. 

11. The opinion of the existence and agency of such a poison 
will appear the more natural, when we find that the danger of an 
attack is generally proportionate to the proximity to localities 
where these diseases prevail ; — the other agencies being the same 
beyond as within the sphere of their prevalence ; — that vessels on a 
sickly coast remain healthy so long as they do not approach the 
land ; that they become again healthy by removing to a short dis- 
tance, or by merely shifting their position; and that individuals 
from on board, who land, and those especially who sleep on shore, 
are almost certain of being attacked. 

12. The development and prevalence of fever on board of ships, 
when other vessels in the vicinity remain healthy; its occurrence 
only in limited parts of the under decks; and its being arrested 
by a proper system of expurgation, lead to the opinion of the 
generation and existence there of a morbific poison. 

13. The innocuousness of some marshes, of ships in a foul state, 
or of surfaces bearing a strong resemblance to others in which 
periodic fevers prevail, is no proof that exhalations issuing from 
sickly places or ships, are not the cause of the disease ; for, besides 
that the latter is often traced to some source of decomposition in a 
way to leave no doubt as to the agency of these, the exemption 



AUTUMNAL FEVERS. 331 

may be j ustly attributed to the existence, in some instances, or to 
the absence, in others, of a variety of necessary and concomitant 
circumstances. Fevers do not prevail beyond a certain altitudinal 
range ; they require a certain amount of heat, and that this heat 
should be continued during a certain length of time; they require, 
besides, a certain amount of terrestrial humidity, no more nor less ; 
or, at least, that the soil should have been well saturated before 
being exposed to the prolonged operation of the solar heat ; also, a 
close and still atmosphere, and other contingencies adverted to. 
Without these they do not appear to show themselves, how favour- 
able soever to their generation may be the condition and nature of 
the soil or the substances by which it is covered or permeated. 

14. The malarial doctrine receives farther support from the well- 
attested fact, that the cause of fever is carried by the wind from 
paludal and sickly localities to places situate at considerable dis- 
tances; the latter places remaining healthy so long as they are to 
windward of the others, and becoming sickly when they are to lee- 
ward. In such cases, the wind cannot have carried an amount of 
heat or humidity sufficiently different from that existing before to 
account for the effect produced. Nor can it act by occasioning a 
much greater amount than usual of atmospherical vicissitudes. 
Hence the cause, to be thus wafted from one place to another, and 
to give rise to a particular disease, similar to that of the locality 
from whence it proceeds, must consist of a material poison, mixed 
with, or suspended in the atmosphere. 

15. Equally favourable to the correctness of the belief is the 
effect resulting from the upturning of soil in hot weather. The 
injury resulting from this operation, as illustrated by a wide dif- 
fusion of malarial fevers, and the great mortality often occurring on 
the levelling of streets, digging ditches and canals, cutting down 
bluffs, caving in of river banks, &c, cannot be accounted for on the 
principles advocated by the opponents of the malarial doctrine, and 
are more easily explained on the supposition of a poison exhaled 
from the decomposed organic matter contained in freshly exposed 
earth. 

16. The effect of partial draining; of exposing a virgin soil to 
the action of the sun ; of the imperfect desiccation of the soil after 
an overflow, and other kindred occurrences, in producing or in- 
creasing fever; and the converse effect of complete draining, of 
covering a marshy surface with water or sand ; or masses of decaying 



332 PNEUMONIA AND 

organic materials, or any other unhealthy place, in the same way, 
or with earth, in putting a stop to fever, lead to the same con- 
clusions. 

17. Agreeably to no other doctrine than the malarial, can we 
explain the greater sickliness of marshes formed by the mixture of 
salt and fresh water ; for this mixture cannot increase any of those 
influences to which others attribute diseases thus produced or 
aggravated ; while we can understand that the mixture may act 
injuriously, by furthering the decomposition of the organic matter 
which it saturates, as well as by the reciprocal destructive action of 
fresh water on the living beings contained in sea-water, and re- 
versely, the destruction by the latter of those contained in fresh 
water. 

18. The limitation of the disease to a restricted locality, to a few 
streets or buildings, to one house, or side of a house, or one room, 
&c, bespeaks, as do like occurrences on shipboard, the existence of 
a local cause of infection, and consequently the exhalation from 
this of a morbific agent, 

19. The opinion of fever being due to the introduction into 
the system of a morbid poison, floating in the atmosphere of 
sickly places, receives a strong support from the analogy existing 
between their symptoms and anatomical lesions, and those resulting 
from the introduction of putrid organic matter into the circulation, 
or the inspiration of putrid vapour. 

20. The arresting or mitigation of fevers in sickly localities by a 
resort to proper hygienic means, disinfectants, washing, excessive 
heat, &c, lead to the same opinion ; for these means operate in the 
same manner on other morbific causes the effluvial nature of which 
is undoubted, while they have no efficiency in cases of diseases 
arising from other agencies. 

21. The effects of trees, walls, hills, buildings, curtains, &c, in 
arresting the transit of the cause of fevers, are equally favourable 
to the idea of that cause being a malarial poisonous substance 
contained in the atmosphere. 

22. Still more conclusive is the destruction of that cause by frost, 
for the latter cannot produce its beneficial effects by an action on 
any of the other agencies to which fevers are ascribed ; while it is 
known to exercise the same destructive influence over other causes, 
of a character similar to the one from which fever originates. 

23. The wide prevalence of autumnal fevers in certain localities ; 



AUTUMNAL FEVERS. 333 

the great mortality to which they sometimes give rise; and the 
diffusion of some forms of them over a very large expanse of 
country, at a time, too, when the sensible qualities of the atmo- 
sphere do not appear to have varied in any important point from 
what they are in healthy seasons, afford an additional reason for 
attributing them to a toxical agent floating in the atmosphere. 

24. The transmission of the disease to the foetus in utero; its 
production from the internal use of the waters of marshes ; the 
inability of such waters to sustain life in fish and other animals 
of the kind ; the undermining effect of a malarial atmosphere on 
the system ; the production by it of a state of cachexia, and its 
influence in shortening the duration of life, indicate the existence 
and agency of a poisonous substance transmissible, in the one case, 
like other morbid poisons, by the mother to the child she bears in 
her womb ; in another case capable of solution in the water which 
helps to its generation ; and in others, again, endowed, like well- 
known poisons, with the power of gradually occasioning peculiar 
and injurious changes in the blood and vital organs. 

25. The neutralizing influence exercised by the poisons of some 
zymotic diseases over the agent producing malarial fevers, would 
seem to indicate the existence of a close analogy between the latter 
and the former. The same remarks are applicable to the patho- 
genic antagonism existing between malarial and typhoid fevers. 

26. Lastly, from all that we can gather respecting the origin, 
mode of progression, and phenomena of autumnal fevers, the nature 
of the localities they visit, the circumstances under which they 
appear, the agencies which promote their development, or retard 
or arrest their progress, we may conclude, without fear of error, 
that everything tends to connect the morbific agent, of which 
autumnal fever is the offspring, with the products of the decompo- 
sition of organic materials ; requiring as it does, for its generation, 
the action of the very same agencies which are necessary for that 
decomposition. Like the latter, it requires the presence of the 
above materials; like the ordinary decomposition of these, the 
febrile cause requires for its generation a more or less prolonged 
continuance, and a certain degree of atmospheric heat ; it requires, 
also, a certain amount of moisture. In the one as well as the other 
process, an excess of this moisture prevents or arrests its progress ; 
in the one as well as the other, a total absence of the same produces 
a like preventive or destructive effect. The generation or diffusion 



334 PNEUMONIA AND 

of the febrile cause is promoted by a calm and close state of the 
atmosphere, and retarded, prevented, or modified, by free ventila- 
tion, elevated situations, and a pure quality of the atmosphere. Like 
ordinary decomposition, the process by which the febrile cause is 
produced, is retarded by cold, and arrested by frost, as well as by 
intense heat. 

Now, as has been said before, when we find the cause of fever 
requiring for its development the action of the very agencies which 
are necessary to insure the development of the gaseous products of 
decomposition; when we find that without these agencies, applied in 
certain proportions, neither those gaseous products nor the efficient 
cause of fever will manifest themselves ; that in all instances in 
which the latter is produced, as shown by the occurrence of fever, 
materials capable, when acted upon by the agencies in question, of 
giving rise to the evolvement of the gaseous products of decompo- 
sition — organic matter in various conditions and states of modifica- 
tion — exists ; that the total absence of those materials, whatsoever 
be the degree of heat, and of terrestrial and. atmospheric moisture, 
carries along with it an equal absence of fever ; and that, when 
once formed, the gaseous products of decomposition, as well as the 
febrific cause, are cut short by frost or intense heat, and the pro- 
cess by which they were generated arrested ; when, I repeat, all 
these circumstances are borne in mind, we can have no reason to 
doubt the propriety of admitting that the febrile cause presents 
a close analogy to the above-mentioned gaseous products ; and that 
if, in regard to the latter, heat, humidity, and other agencies acting 
in given proportions and in concert on dead organic matter, give 
rise to certain products which assume the gaseous form ; and if the 
process of the generation of these, and their existence in the atmo- 
sphere is destroyed by frost or intense heat ; the febrile poison which 
requires for its generation the action of the same agencies, as also 
the existence of a kindred matter, and is besides arrested in its 
formation, and destroyed when formed in the way mentioned, must 
necessarily consist also of some modification of a similar kind of 
gaseous substance ; in other words, that autumnal fevers must be 
the offspring of a malarial morbid poison, and not the effect of 
modifications in the sensible qualities of the atmosphere. 



CHAPTER V. 

PNEUMONIA AND AUTUMNAL FEVER COMPARED IN RE- 
FERENCE TO THEIR CAUSES, MODE OF PROGRESSION, 
SYMPTOMS, ANATOMICAL CHARACTERS, AND THE CIR- 
CUMSTANCES BY WHICH THEY ARE INFLUENCED. 

The causes of autumnal fevers and pneumonia are different. — In 
the preceding chapters, I have endeavoured to prove, by facts and 
arguments, that autumnal fevers, in their several varieties and 
forms, from the simple intermittent to the malignant yellow fever, 
are produced by specific toxical agents, exhaled under the modi- 
fying action of certain contingent influences, heat, humidity, &c. 
from organic substances during the process of decomposition ; 
and those agents I have, in imitation of Dr. Irvine, who first 
borrowed the term from the Italians, designated by the generic 
name of malaria. Whether the attempt to establish, in a satisfac- 
tory manner, the correctness of this generally admitted but some- 
what contested belief has been successful or not, must be left to 
the decision of the reader. Convinced, however, from all I have 
seen or read, that the majority of those who have investigated the 
subject with due accuracy, learning, and impartiality, will affirm 
the conclusions to which I have arrived; unable to discern, in the 
writings of the opponents of the malarial origin of fevers, anything 
calculated to weaken, in the least, the force of what has been 
adduced in its support ; and fully satisfied that none of the other 
agencies to which those diseases have been, at times, ascribed, can 
give rise to their phenomena, I have no hesitation in regarding 
that mode of origin as a fact placed beyond the possibility of doubt. 

Now, if while entertaining these sentiments — while holding au- 
tumnal fevers to be the morbid products of the poisons in ques- 
tion — we lend a willing ear to the speculations of those, who, 
reviving a long-exploded hypothesis, contend that the same dele- 



336 PNEUMONIA AND 

terious agents which pro'duce fevers will also produce pneumonic 
inflammation ; and if, from this supposed similarity of origin, we 
argue that pneumonia is really and substantially nothing more 
than a peculiar form of remittent and intermittent fever, we shall 
be inevitably led to the conclusion, that malarial exhalations may 
and do give rise, in some localities, and under certain circumstances, 
to inflammation of the lungs. Nor is this all. Experience, as I 
have endeavoured to demonstrate in a former chapter, teaches that 
pneumonia occurs, and even prevails extensively, under circum- 
stances when malaria cannot, in the most distant manner, be 
suspected to have been an efficient and necessary agent in its pro- 
duction — as, for example, in places where the poison is not evolved, 
or, if so, is harmless ; or in seasons of the year when, supposing it 
to have existed or produced its characteristic effects before it has 
been destroyed through the influence of frost or other disinfecting 
means. In all such localities and seasons (as the reader cannot fail 
to perceive), it follows that the disease, when it occurs, must be due 
to the operation of morbific agencies, different from those to which 
autumnal fevers have been distinctly traced. The conclusion is 
inevitable, and, if while taking it into consideration, we admit the 
reality of the peculiar effects assigned to malarial exhalations — if 
we consent to regard these as prolific causes not only of autumnal 
fevers but of pneumonic inflammation also — we shall be compelled 
to recognize the possibility of the latter disease being, not only in 
different localities and in different seasons of the year, but every- 
where, and at all times, the offspring, indiscriminately, of two sets 
of causes, which, on examination, will be found to possess very dis- 
similar characteristics and properties. Hence, we shall have the 
rather anomalous phenomenon of one and the same disease some- 
times springing from the operation of a toxical agent — the more 
ordinary, or indeed legitimate effect of which is the production of 
autumnal fevers — and at other times resulting from morbific influ- 
ences, which, whatever be the variety of the diseases they really 
produce — a question we have nothing to do with at present — have 
never, so far as can be discovered, occasioned, alone and unaided 
by the former agent, an attack of pure remittent, intermittent, 
yellow, or kindred fevers. To conform ourselves to the language 
of our opponents, we shall have an example of one form of 
periodic fever, i. e. pneumonia, produced by a particular cause — 
malaria — which gives rise also to other forms assumed by that 



AUTUMNAL FEVERS. 337 

Protean disease — remittent, intermittent, and yellow fevers ; while 
in other and more frequent instances, the aforementioned form, 
pneumonia, springs from the action of other and very different 
morbid influences, prolific in inflammations of that sort, but differ- 
ing widely from malaria in this, that they cannot give rise to the 
fevers in question. In a word, admitting the views referred to to 
be well founded, the so-called pneumonic form of autumnal fever 
may be produced by either of two sets of causes; the one of which, 
at the same time that it occasions that effect, is the active agent in 
the production of the more legitimate form of the disease ; while 
the latter form of disease — true autumnal fever — results from the 
operation of but one of these sets of causes — malarial poison — and 
has never yet been satisfactorily traced to the baneful influence of 
those other agents, which are acknowledged to produce the pneu- 
monic form. 

IN ow, it is not presuming too much to say that there is not one 
solitary case, authentically recorded, and adduced by an individual 
competent to decide in matters of the kind, in which genuine pneu- 
monia can be truly said to have been produced solely by the well- 
ascertained cause of autumnal fever, and which can thereby enable 
any one to demonstrate, in a satisfactory manner, the connection, 
as cause and effect, between malaria and that disease. That a con- 
gested state of the lining membrane of the bronchial tubes, allied 
to inflammation, exists in many cases during the cold fit of an 
ague, may be and is doubtless true. The strong, sonorous rale, 
which totally disappears on the accession of perspiration, indicates 
this condition, and has been noticed too often to be denied. There 
may exist, also, during the cold stage, some congestion of the lungs, 
which occasionally may approximate to the first stage of pneu- 
monia. But these conditions are the effects of the mere concentra- 
tion of blood in the internal organs, and occur in all complaints 
attended with a chill. They do not amount to positive inflamma- 
tion; and, besides, do not present themselves in other forms of 
malarial fevers in which the chill is feebly marked and not repeated. 
None, indeed, of the circumstances connected with the evolvement 
and dissemination of malaria, whose legitimate effect is the produc- 
tion of autumnal and periodic fevers of various grades and types, 
in localities where the proper materials of decomposition exist, will 
be found to prove instrumental in causing pneumonia or other 
diseases of a kindred character. Nor can it be proper to look to 
22 



338 PNEUMONIA AND 

the products of such decomposition to account for the occurrence 
of pulmonary inflammation in malarious localities and seasons, 
■unless we feel disposed, at the same time, to ignore,, in such places 
and at such periods, the morbific influence in the production of the 
disease, of the causes which are acknowledged to produce that same 
disease in situations where, and at times when, malaria does not 
and cannot be admitted to float in the atmosphere. In other words, 
before doing so, it will be necessary to prove that in localities or 
seasons noted for the evolvement of malaria, the ordinary causes of 
pneumonia do not prevail, or, if they do, remain perfectly harmless, 
and allow their rival in mischief to produce alone effects, to which, 
under other circumstances, they themselves give rise. It is scarcely 
necessary to remark, that there is nothing in the atmosphere of a 
malarious locality capable of excluding the ordinary causes of 
pneumonia; and in maintaining that they there assert their sway 
as freely as when the air is not tainted by morbid effluvia, we do 
not sin against the canons of that system of philosophy on which 
some of our opponents lay so much stress. Now, if such morbid 
influences exist as well in malarious as in other localities ; if nothing 
can be pointed out capable of preventing the morbid effects they 
produce in the latter from being produced also in the former, it is 
certainly needless to have recourse to such effluvia for the purpose 
of accounting for the occurrence of that disease ; for when the latter 
occurs under such circumstances, it may fairly be attributed, not to 
malaria, but to the operation of its ordinary causes. The conclu- 
sion will appear still more natural when we bear in mind a fact 
already adverted to, that none of the conditions of locality, which 
are inimical to the formation of malaria, as well as none of the 
hygienic means by which the evolvement of the poison is arrested 
or diminished, have the effect of preventing or lessening the pre- 
valence of pneumonia. The disease continues to present itself as if 
no changes had been made in the surrounding circumstances, and 
we are justified in presuming that the same causes which give 
rise to it after the extinction of malaria have produced it hefore that 
extinction. 

But let us admit, for the sake of argument, that in all I have 
advanced on this subject, I err. Let us admit that sporadic pul- 
monary inflammation — catarrhal or parenchymatous — is produced 
occasionally, or often, by the malarial poison, and that the epidemic 
forms of the disease are due to the same cause ; I am not sure that 



AUTUMNAL FEVERS. 339 

the admission will afford much help to those who feel disposed to 
argue, from this circumstance, that pneumonia is only a peculiar 
form of periodic fever. In the first place, the conclusion, if well 
founded, would only apply to those particular cases which occur 
where malaria is known to be evolved ; for, as we have seen, and 
as is acknowledged, inflammation of the lungs presents itself under 
circumstances when it must be due to the operation of other mor- 
bific influences, and cannot, therefore, be viewed as closely con- 
nected with the fevers in question. In the second place, whether 
pneumonia be produced by one or the other of the causes, from 
the action of which it is well-ascertained to originate, it is, to all 
intents and purposes, the same disease ; it is simply pneumonia, and 
nothing else. If produced by malaria, the same thing would occur 
— the morbid effects produced on the lungs would be the same, as 
if they were the result of any of their ordinary causes. The dis- 
ease would not be, because thus produced, autumnal fever, but 
simplv pneumonia. If unmixed with unusual morbid elements, it 
would be governed by the same laws as other cases ; it would be 
recognized by the same symptoms ; would present the same ana- 
tomical characters, and would call for the same treatment; while, 
in cases presenting the unusual elements above alluded to, these 
would constitute an addition to the original elements of the disease, 
by which the latter would be complicated and more or less modi- 
fied, without, however, being altered in its essential characters. 

2. We have seen, in a preceding chapter, that the prevalence of 
malarial fevers, of various grades and types, is restricted within 
certain localities ; that, in many instances, the area of these infected 
places is very limited in extent; that while the disease prevails in 
one spot, individuals who reside at a short distance, and abstain 
from visiting that spot, escape ; that by removing from one part of 
the same city to another not far distant, or from one end or side of 
a house to another, or from a lower to a higher story, the disease 
may be avoided ; that ships, by shifting their position from one 
part of a sickly port or shore to another close by, are often found 
to lose the fever from which, before the change, they had suffered 
severely. We have seen, on the other hand, that in certain locali- 
ties, the crews of vessels that had been exempt from fever so long 
as they remained at only a short distance from land, were attacked, 
sometimes to a man, as soon as they ventured ashore ; and that 
individuals who had enjoyed good health while avoiding infected 



340 PNEUMONIA AND 

city or country localities, were attacked, with an almost unerring 
certainty, in consequence of visiting or passing through them. 
Now the physician who should undertake to collect facts to prove 
that the sphere of prevalence of pneumonia is as narrowly circum- 
scribed as it is sometimes found to be in fever, would have an 
ungrateful task to perform. We nowhere hear of this disease 
attacking a large number of the residents of a limited spot, of a 
part of a street or house, and leaving every one in the close vicinity 
of that spot, in the next street, or in the adjoining houses, perfectly 
unscathed. Nor need we fear to predict that the medical writer 
who ventures on the assertion that pneumonia has frequently been 
observed to attack the occupants of the lower rooms of houses, or 
the basement wards of a hospital, and to scrupulously respect those 
who dwell above ; that all the inmates of one end of an asylum, 
hospital, prison, or house, have been struck down by inflammation 
of the lungs, while those occupying the other parts of the same 
building have remained untouched — and that, too, not during one 
season, but during a succession of seasons — will run great risk of 
giving but an unfavourable opinion of the authenticity of his facts, 
or the soundness of his judgment. We do not hear of the crews of 
ships ridding themselves of the disease in question, by shifting their 
position, and anchoring at the distance of a few dozen yards ; or of 
vessels, which before had been healthy, becoming, by a reverse 
change or the removal of an intervening ship or other object, sud- 
denly visited with the disease. Neither do we find a large number 
of instances on record of vessels which were free so long as they 
remained under sail, or at anchor at a short distance from an in- 
fected shore, being filled with pneumonic cases the moment they 
approached close to the land, or sent their boats to explore the 
mouths of rivers, &c; or, again, of scores of individuals, who had 
remained healthy while residing at a short distance, being attacked 
with pleurisy or pneumonia in consequence of jumping over the 
barricades, and promenading about the streets of an infected spot. 

3. It has been seen that the cause of autumnal fever is wafted 
by the wind ; that the disease prevails in localities situate in such 
a way as to receive, through that means, the malarial exhalations 
evolved from local sources of infection ; while other localities placed 
in a contrary direction, though at a very short distance, escape 
more or less completely. It has been seen, also, that the effect does 
not depend upon the particular point of the compass, abstractly 



AUTUMNAL FEVEES. 341 

considered, whence the wind happens to blow, but upon the posi- 
tion the suffering locality occupies relatively to marshes or other 
sources of morbid effluvia. Again, we have seen that the disease, 
thus produced, will be arrested in, or diverted from, its course by 
a hill, a row of trees, a wall, a -curtain, or other such causes of ob- 
struction; and, on the contrary, that places heretofore healthy have 
become infested with fever, by simply removing such obstructions 
and allowing a free access to some particular wind. The history of 
pneumonia furnishes us with nothing of the kind. It presents no 
example of the disease being produced or prevented in this way ; 
of its causes being wafted by a particular wind passing over an in- 
fected locality ; of its course being impeded by hills, trees, walls, 
and curtains ; or of cases of it being multiplied by the removal of 
these. That cold winds will, as we shall see, produce, under par- 
ticular circumstances, cases of pneumonia, is doubtless true; but it 
should be borne in mind that it matters not whether such winds, 
in order that they may occasion that effect, pass over sickly or 
healthy localities, while their real agency in the matter is without 
difficulty accounted for by the sudden production of one or more 
of the ordinary causes of the disease. 

4. We have seen that the overflow of the sea, of lakes, of 
rivers, or other sheets or streams of water; the establishment of 
mill-dams ; the digging of canals ; the levelling of streets ; the partial 
draining of marshy surfaces ; the clearing of new land, and the like, 
are fruitful sources of fevers. We have seen that these are produced 
by exhalations from masses of decaying or green timber, or of 
other vegetable as well as of animal substances, separate or com- 
bined, in a state of decomposition. Where, may it not be asked, 
shall we find well-authenticated instances of pneumonia produced 
by such occurrences, unless they bring along with them some of 
the ordinary and well-known causes of the disease ? Apart from 
these causes those occurrences are harmless, so far as thoracic in- 
flammations are concerned. 

5. Facts in large numbers have been adduced to show the salu- 
tary effects of complete drainage in putting a stop to, or in dimi- 
nishing, the prevalence of fevers. While such is the constant result 
of this measure in regard to those diseases, no change is effected so 
far as concerns pneumonia, which generally continues to show itself 
as if nothing had occurred. We have seen that the same salutary 
effects, as regards fevers, have followed the complete flooding, by 



342 PNEUMONIA AND 

artificial or natural means, or the washing of insalubrious localities. 
So far, nothing has been pointed out calculated to show that from 
such occurrences have resulted like salutary effects in respect to 
pneumonia, the number of cases of which does not seem to be 
smaller when* the country at large is deluged with water, than 
when it is but partially covered ; or after a heretofore sickly locality 
has been ricl, through the effect of rain or otherwise, of all sources 
of malarial exhalations. 

6. We have seen that autumnal fevers, the offspring of malarial 
exhalations, prevail sometimes to an extraordinary extent in certain 
localities, and that, on particular occasions, they spread over a wide 
expanse of country, striking down at once, or in rapid succession, a 
large portion of the population, and causing among them a consider- 
able mortality. We have seen, also, that while in certain localities 
such fevers prevail extensively, and occasion a great loss of life, in 
other places, situate close by, and differing little from the former 
in climate, altitudinal range, and other particulars, they attack but 
few, and give rise to a small proportional mortality ; that in some 
of the West India Islands, for example, the deaths among the troops 
have amounted to 104.1 per 1,000 (Tobago), while in others (St. 
Vincent's and Barbadoes) they have not reached 12 per 1,000. No- 
thing of the kind will be found to hold good as regards pneumonia, 
which in ordinary times is, comparatively at least, a disease of 
unfrequent occurrence; prevails in the same place to very much 
the same extent at each return of its appropriate season; or, if it 
varies in that respect, does so on account of corresponding changes 
in the sensible qualities of the atmosphere; prevails to an equal 
extent in each of the several places where fevers are so unequally 
distributed ; occasions everywhere much the same rate of mortality ; 
and, at periods of its widest epidemic diffusion, neither attacks by 
far so large a number of individuals, nor causes so immense a loss 
of life, as we find to be the case with regard to the other disease. 

7. It is a fact placed beyond doubt, that malarial fevers, what- 
ever be the form they assume, are more likely to be the result of 
exposure, in infected localities, to night air, by which the poison 
may very naturally be understood to be condensed and rendered 
more prolific of disease. During the various epidemics of yellow 
fever in this city, the baneful influence of night air was manifested 
in such innumerable instances as to leave no doubts on the subject 
in the minds of physicians conversant with the disease, by some of 



AUTUMNAL FEVERS. 343 

whom it lias been recorded in emphatic terms. 1 Dr. Merrill, already 
cited, in a private communication to the present writer says, in 
reference to the yellow fever of Natchez : "I know of no instance in 
which the disease was ever taken from exposure in the daytime, and 
then returning home to the country." This only confirms an observa- 
tion very generally made at every 'epidemic return of this form of 
fever in tropical and temperate climates. The same holds good in 
regard to remittents and intermittents everywhere, abroad or at home; 
even under circumstances when the greatest attention is paid to guard 
against the action of ordinary morbific influences. 2 I am not aware 
that pneumonia, in regard to the peculiarities attending its produc- 
tion, is governed by any law of the kind. Its causes are operative 
by day as they are by night. When proper precaution is taken, 
during the latter period, to shield the body from their effects, the 
disease will be easily avoided. But when the same precautions are 
not attended to during the day, the disease is as apt to follow then 
as at any other period. Even admitting this not to be true, expe- 
rience teaches that night exposure is not more dangerous, so far as 
regards this disease, in a malarial than in a non-malarial locality ; 
the condition of soil, temperature, and other contingencies being 
the same in all; whereas, the contrary is the case in reference to 
autumnal fevers, which follow on such exposure only in certain 
localities. 

8. Nor are we to lose sight of the fact pointed out by very 
reliable authorities, and which experience everywhere confirms, 
that the production of fevers is favoured by the state of sleep. 
Dr. Eush, in his account of the epidemic of 1793, says : "A great 
proportion of all who were affected by this fever, were attacked in 
the night. Sleep induced direct debility (which he afterwards 
called debility by abstraction), and thereby disposed the contagion 
(malaria), which floated in the blood, to act with such force upon 
the system as to destroy its equilibrium, and thus produce a fever. 
The influence of sleep, as a predisposing and exciting cause, was 

' Rush, Fever of 1793, p. 50; Works, iv. 18, 85 ; Deveze, 113, 114; J. K. Mitchell, 
53, 54; Chapman, Phil. Med. and Phys. J. viii. 319 ; Emlen, N. A. J. v. 327; Cald- 
well on Miasm, 507; do. on Malaria, 128, 144; Wood, i. 314. 

2 Crant, 58; Moultrie, 62; Valentin, 228; Lempriere, ii. 113; Darfcste, 218; Rollo, 
144; Arnold, 60; Celle, 292; Caillot, 260; Bally, 590; Bryson, 217; Brocchi, 260; 
J. Johnson on Trop. CI. 73 ; Rigaud de L'Lsle, in do. 312 ; Gilbert, 81 ; Barton, Fev. 
of Hong-Kong, Dublin J. (N. S.) xii. 344-347. 



344: PNEUMONIA AND 

often assisted by the want of bedclothes suited to the midnight or 
morning coolness of the air." That such an agency has been called 
in question by Dr. Deveze (114, 115), and others, is doubtless true. 
But by reference to some of the older and many later and contem- 
porary writers, from Lancisi to the present day, we shall find state- 
ments of facts observed in Europe, Asia, Africa, and America, 
which confirm the views of our eminent countryman. 1 Speaking 
of the remittent and intermittent fevers of Peru, Ulloa long ago 
remarked : " Quand ces filvres regnent dans les Quebradas (or deep 
valleys) il suffit <$y sojourner pour en etre pris; qu on y dorme de nuit ou 
dejour, on ne les evite pas." 2 Nor can the effect be matter of astonish- 
ment. Every one knows that certain functions are modified in a 
more or less marked degree by the state of sleep. Dr. Edwards 
has shown, 3 and the same observation was made before by Sancto- 
rius and Keill, that the state in question has a tendency to increase 
the perspirable process. At the same time, the nervous energy is 
diminished, the circulation is less rapid, calorification is lessened, 
other functions are performed with less energy, and the whole 
system is in a state of relaxation. In a word, the body is in a 
condition calculated to impair greatly the elimination of the malarial 
poison, and thereby favour its morbific impression on the system. 
That the state of sleep may, for the same reason, render the body 
more susceptible to the action of other morbid agencies — even of 
those which give rise to pneumonia — and that hence the attack, in 
some instances, may have been due to exposure to cold during that 
state, no one is justified in denying. But such cases are compara- 
tively seldom encountered; and in fenny districts or infected 
localities, persons who fall asleep in the open air at night, during 
the sickly season, are not more than ordinarily liable to attacks of 
pneumonia, or at any rate not more so than if no cause of infection 
existed; while in other localities, during corresponding seasons, 
but where such causes do not exist, sleeping in the night air may not 

1 Lancisi, op. tit. 77; Bancroft, 86, 87, 100, 172; Lind on Seamen, 75 ; lb. on Hot 
CI. 192, 283; Wood, i. 144; Simons, 18; Bryson, 218; Wallace, Edinb. J. xlvi. 273 
Monfalcon, 196 ; Alibert, 235; Folchi, N. A. J. vii. 258; Clark's Notes on Italy, 10 
Blane on Seamen, 230 ; Edinb. Rev. xxxvi. 546 ; Celle, prat, des Pays Chauds, 298 
Watson, Tract. 450 ; Brocchi, Stato Fisico de Roma. 

2 Ulloa, Memoires Philosopliiques Hist. Physiques concernent la Decouverte de 
l'Amei-ique, i. 245. 

3 On Physical Agents, 102, Am. ed. 



AUTUMNAL FEVERS. 345 

be indulged in with impunity unless the same precautions are used 
as would be necessary in the daytime. 

9. We have seen that the development of fever may be pre- 
vented, and its progress arrested, by the judicious use of disin- 
fectants—by smoke, the sprinkling of lime, the lighting of fires ; 
by the clearing and washing of gutters, sinks, and sewers ; by the 
removal or covering over of sources of infection. No such means 
have ever, to my knowledge, prevented the development or arrested 
the progress of pneumonic inflammation, among the inhabitants of 
any locality, large or small. To this, let me add that in malarial 
localities, where fevers are rife, and exposure early in the morning 
is almost sure to be followed by an attack, it has been found useful 
to avoid going out on an empty stomach or without taking a small 
quantity of ardent spirits, or a cup of hot coffee. From this has 
doubtless arisen the custom, so prevalent in some parts of tropical 
countries — in Martinique, Guadaloupe, Guiana, Cayenne, &c. — of 
taking a cup of strong infusion of the latter on rising in the morn- 
ing. By means of this substance, the bitter principle of which 
bears some analogy to that of cinchona, intermittent fevers, as we 
learn from Moreau de Jonnes, are frequently prevented. The same 
effect is obtained by bark itself, or some of its salts taken in the 
same way. When the French army encamped in the morasses of 
Mantua, the soldiers were all made to take, at the dawn of day, a 
portion of tincture of bark, and from this precautionary measure, 
which was long ago recommended by Lincl and other writers, the 
most beneficial results were obtained. 1 These precautions will serve 
very little purpose against pneumonia. 

10. We have seen that fevers are in very many instances the 
result of a solitary and transient exposure to an infected locality ; 
indeed, that the large majority of those who thus expose them- 
selves, run an imminent risk of an attack. In regard to pneumonia, 
not one probably in thousands would be in danger from such ex- 
posure in any locality ; and in those so attacked, after a visit to an 
infected spot, the disease would easily be traced to a disregard of 
precautionary measures absolutely necessary everywhere to guard 
against the disease, and which have no connection whatsoever with 

1 Blane, Dissertations, i. 221 ; Bryson, 227 ; Aubert Roche, Mem. sur l'Acclimate- 
ment, An. tl'Hyg. xxxiii. 23 ; Monfalcon, op. cil. 282 ; Celle, Hygiene des Pays Chauds, 
347, 3G7 ; Moreau de Jonnes, Hygiene Militaire des Antilles, 67 ; Lind on Hot Climates, 
317, 318; Thevenot, 95; Caillot, 264; Rollo, 147. 



346 PNEUMONIA AND 

the special causes of autumnal fevers, while the danger would not 
be greater in sickly localities than elsewhere. 

11. It has been stated, on respectable authority, that in both the 
West and East Indies, places where the mangrove and mancinellas 
grow luxuriantly, the most unhealthy spots are those in which the 
roots of those plants are only occasionally and partially under 
water ; and that in tropical climates the existence of a large quan- 
tity of astringent plants, the bark of which is rich in animal matter 
combined with tannin, is generally connected with the development 
of fever. What reason have we for believing that these circum- 
stances exercise an influence on the development of pneumonia ? 

12. Epidemics of fever are on very many occasions attended 
with a wide-spread disturbance in the health of the population at 
large — a considerable number of individuals, though not labouring 
under the fully-formed disease, exhibiting one or more of its symp- 
toms in a mitigated form, and bearing the marks of the cause hav- 
ing produced an impress on the system, as shown by the condition 
of the eyes, the secretions, the alimentary canal, the brain and 
nerves, the blood, &c. We do not find such a result to obtain 
during seasons when pneumonia is most prevalent. 

18. Neither do we find that in those seasons the lower orders of 
animals or plants suffer in a way corresponding to that they are 
often found to suffer in times- of fever epidemics. 

In fine, the more we examine the question at present before us, 
the more inclined we must be to adopt the opinion, that pneumonia 
is never produced simply by the introduction into the system of a 
malarial poison by which the atmosphere of an infected locality is 
polluted ; for, when the disease attacks individuals exposed to the 
influence of such places, it may be traced to the operation of other 
agencies, which prevail contemporaneously with the poison in ques- 
tion, and cannot fail to exercise their baneful effects in an impure, 
as they do in a pure locality. Nor can we greatly err, when we 
affirm that if those agents produce pneumonia in places where the 
malarial influence does not extend, where malaria is never evolved, 
or where its evolution, if it has taken place, has been completely 
arrested, as proved by the constant absence or cessation of its legi- 
timate effects — fevers — it is to them we must look for the true 
cause of the development of the disease when it shows itself in 
infected localities, and not to the exhalations by which the atmo- 
sphere of those localities may be contaminated. So long as care is ' 



AUTUMNAL FEVERS. 347 

taken to avoid the action of those agencies, exposure to malaria 
may produce fevers ; but no quantity of it received into the system 
will occasion pneumonia, which, in fever localities as elsewhere, 
owes its origin to the operation of the same causes. 

Causes of Pneumonia. — As regards the nature of the morbific 
influences in question, it will not be necessary to say much in this 
place. Every one conversant with the subject, whether in or out 
of the profession, knows full well, that pneumonia and all other 
kindred affections of the thoracic organs, are very usually due, not 
in one place and in one season only, but in all places and at all 
times, to atmospheric vicissitudes, to exposure to cold, especially 
when the body is hot and perspiring, to currents of cold air, and the 
like. 1 Dr. Barton, of New Orleans, who has paid much attention 
to meteorological subjects, informs me, in a private communication, 
that "Pneumonia is most apt to occur at variable temperatures 
from 20 to 50 — with a low dew-point, and great drying power, 
producing rapid evaporation from the surface of the lungs and 
skin." Add to these sundry physical and local causes — violent 
exercises of the voice, irritating vapours, and asphyxiating gases, 
blows on the chest, wounds of the lungs ; the translation by meta- 
stasis of gout, rheumatism, cutaneous diseases ; the transfer of 
inflammation or purulent deposits after extensive wounds in vari- 
ous parts of the body, or important surgical operations. 2 Expe- 
rience teaches all this; and teaches, besides, that the prevalence of 
pneumonic inflammation in each system of climate increases and 
decreases in proportion, not as the evolution of malaria increases or 
decreases, but as the seasons are contrasted ; thus maintaining, as 
Dr. Forry has correctly pointed out, an unvarying relation with the 
extreme range of the thermometer as connected with the seasons. 
In other words, we find that the ratio of those diseases is highest in 
proportion as the difference between the temperature of summer 

1 Hildebrand, Inst. Pract. Med. iii. 194; Bouillaud, Diet, de Med. Pract. xiii. 359; 
lb. Med. Clin. ii. 151 ; Grisolle, 147; Swett, 80, 81 ; Williams, Cycl. of Pract, Med. iii. 
407 ; Chomel, Diet, cle Med. xxv. 104 ; Andral, Med. Clin. i. 512 ; Bartbez et Rilliet, i. 
115; Pinel & Brichetau, Diet, des Sc. Med. xliii. 396; Laennec, i. 546; Forbes's 
Transl. 225 ; Daniel Monro, ii. 247 ; W. Phillip, 204 ; Wood's Pract. ii. 42. 

2 See Sir C. Bell's Surg. Operations; Guthrie on Gunshot Wounds; Forbes's Laen- 
nec ; Williams, Cyclopaedia; Grisolle, 142; Rouppe, 44; J. Frank, 316 ; Lieutaud, i. ; 

^Portal, Anat. Med. v. 72; Andral, Clinical Med. i. 512; Erichsen, Med.-Ch. Trans, 
xxvi. 29. 



348 PNEUMONIA AND 

and winter increases, and lowest in proportion as it grows less ; 
that the stronger the impression on the system by the high tempe- 
rature of the former season, the more susceptible the lungs are ren- 
dered, so far as regards inflammatory complaints, to the morbific 
agency of the opposite seasons ; that those diseases are invariably 
less prevalent in the moist and changeable climate peculiar to the 
sea-coast and large lakes of this country, where malaria is abund- 
antly evolved, than in the dry atmosphere of the opposite locality, 
where the febrile poison is not largely produced. Hence, if pneu- 
monia and pleurisy are more frequently encountered in the Middle 
and Southwest regions of the United States than in the cold and 
variable climates of our Northern and Eastern States, the explana- 
tion is not to be sought in the fact, that the cause of periodical or 
autumnal fevers exist in many sections of those regions, but in the 
circumstance that individuals are placed under the control of the 
law above alluded to ; i. e. the greater impressibility of the thoracic 
organs to cold occasioned by the previous influence exercised by 
long-continued summer heat; and that the effect is equally well 
marked, whether the locality where these diseases are found, be or 
be not the seat of febrile affections, or characterized by the kind of 
soil prone to the production of the latter ; and are likewise noticed 
in climates where, from the peculiarities of the soil, the nature and 
proportionate duration of the seasons, and the range of the thermo- 
meter and hygrometer, they never have originated, and in all 
probability never can originate. 

Another writer, who has investigated the subject on even a 
larger scale than Dr. Forry — Dr. Lawson, of the English army, and 
whose conclusions are drawn from the results obtained among the 
British troops in the different stations scattered over the greater 
part of the earth, remarks, that the frequency of inflammatory dis- 
eases of the lungs, and the amount of the resulting mortality, are 
proportional to the prevalence and activity of the (not malarial 
poison, but) refrigerating causes relatively to the powers of resist- 
ance of the constitution. 1 

Not very different is it in relation to catarrhal complaints, which, 
as we have seen, Dr. Copland and others have classed among the 
products of malaria. Except, perhaps, when it presents itself in the 
garb of what has been denominated influenza — and then it is appa- 

1 Edinb. Med. and Surg J. lxii. 50. 



AUTUMNAL FEVEES. 349 

rently due to some wide-spread and travelling meteorological change, 
of the essence of which we know nothing, but certainly bearing no 
analogy to miasmal exhalation — catarrh is evidently the offspring 
of those atmospheric influences to which other thoracic irritations 
are due; while the idea of its dependence on the specific cause of 
periodic fevers will be found destitute of solid foundation. On this 
subject let the following remarks of Dr. Eorry suffice : — 

" That catarrhal fever has not the remotest connection with ma- 
larial causes, is demonstrated by the statistics of our troops. As 
the ratio of intermittent and remittent fever is about five times 
higher in our southern than northern latitudes, and as that of 
catarrhal affections is twice as high in the latter, it follows that, as 
the results are in an inverse proportion, no relation of cause and 
effect is discoverable. As the classification of Dr. Copland, how- 
ever, limits the production of catarrhal fever to ' temperate ranges 
of atmospheric heat, aided by moisture,' it may be said that it ap- 
plies only to our northern regions. In diametrical opposition, then, 
to this view, it is found that in the winter, when no ' miasm from 
decayed vegetable matter arises, the ratio is twice as high as in 
summer, and that the annual ratio in the moist climate of the lakes, 
and the coast of New England, is not more than half as high as that 
of the dry climate of the region remote from large bodies of 
water.' " l 

All this, let it be said en passant, differs somewhat from the re- 
sults obtained in regard to autumnal fevers, which, in temperate 
regions, where the temperature of the several seasons are generally 
strongly contrasted, often prevail most when a very long hot sum- 
mer succeeds to a very cold winter; and which, on the other hand, 
spread more extensively in tropical regions and in the southern 
regions of this country and Europe, where the seasons are not con- 
trasted, or are so to a limited extent, and which require for their 
development and dissemination meteorological conditions, for the 
most part the reverse of those mentioned in regard to pneumonia. 

But be this as it may, the experience of the world shows that 
although it is not always possible, in all individual cases of pneu- 
monia, and under all circumstances, to arrive at a precise knowledge 
of the cause of the disease, owing to the difficulty of obtaining defi- 
nite and correct information from those attacked, or from the indis- 

1 Climate of the U. S. 305. 



350 PNEUMONIA AND 

tinct manner in which the morbid agent has impressed the system; 
yet, in the larger number of instances, the disease is due to well- 
ascertained injurious influences, not one of which can produce, or 
has ever produced, intermittent, remittent, bilious, or yellow fevers, 
or bears the least analogy to the morbid poisons which give rise to 
these maladies. And it is not a very great stretch -of assumption 
to suggest, that in those instances in which the cause cannot be 
satisfactorily ascertained, it would, if discovered, be found to be 
allied to the former influences, and to have nothing in common with 
the latter. True it is that writers have speculated on the possibility 
of inflammatory affections of the lungs being, under particular cir- 
cumstances, produced by the introduction of certain morbid poisons 
into the circulation, through the agency of respiration or otherwise ; 
and it may be argued that, if we admit this to be the case in some 
instances, the advocates of the malarial origin of pneumonia will 
think themselves justified in maintaining, that what is true of one 
or more poisons, may be supposed to hold equally good in regard to 
the cause of autumnal fevers. Such, for example, has been said to 
be the effect of the poison of the rattlesnake, which, it is affirmed, 
gives rise to pneumonia; and we know that epidemic catarrh or 
influenza, in which the disease extends sometimes to the substance 
of the lungs, as well as epidemic pneumonia, are supposed by 
respectable authorities — among whom, in reference to the latter 
complaint, we find no less a name than that of Laennec 1 — to be due 
to a peculiar miasm floating in the atmosphere ; the reason assigned 
being the universality of the prevalence of those affections, and the 
difficulty of tracing them to any of their ordinary causes. In all 
this, however, we can discover nothing more than conjecture. In 
the first place, the statement respecting the agency of the poison of 
the rattlesnake in producing pneumonia, to say the least, needs 
confirmation. By those most experienced in the matter, it is stated 
that when a rabbit or small animal is poisoned by this snake, it 
gives no evidence of feeling pain, and generally for some minutes 
appears to be well — his ears then begin to droop, giddiness and 
uneasiness follow, and the animal falls; the pupil becomes dilated, 
slight convulsions ensue, and death closes the scene in about fifteen 
minutes from the accident. On examination, it is found that the 
red colour of the blood in the part affected has been destroyed. 

1 Traits de l'Auscultation, i. 547. 



AUTUMNAL FEVEES. 351 

The muscular fibres and cellular substance for two inches around 
the puncture are black, and so is the blood in the veins leading 
from the wound ; that in the heart is darker than natural, and does 
not coagulate so firmly as when the animal has been killed by a 
blow on the head ; the supply of blood to the brain is deficient; but 
neither this organ nor any other solid parts show signs of injury, 
except near the wound, which swells sometimes very considerably. 1 
In man, the symptoms are longer in developing themselves, and 
the disease runs a more protracted course ; but the phenomena are 
similar in kind, and in no instance evince anything indicating the 
existence of pneumonic inflammation. If pulmonary symptoms 
occur, and the lungs are found to present, after death, marks of 
morbid change, the effects are due, in this and other kindred cases, 
to simple congestion, a condition very generally encountered in 
affections characterized by, or combined with a deflbrinated state 
of the blood. 2 

Again ; of the morbific agent which gives rise to influenza we 
know little. Indeed, if we knew more, it is not certain that our 
information would lead to anything of much importance relative to 
the present inquiry ; inasmuch as that agent, whatsoever be its na- 
ture, affects primarily the mucous tissue of the lungs ; and pneu- 
monia, when it occurs, is only consecutive, and not the direct effect 
of the cause producing the primary disease. Moreover, in regard 
to epidemic pneumonia, nothing as yet adduced proves its malarial 
origin. If sporadic cases of pulmonic inflammation can and do arise 
from the operation of causes totally unconnected with the existence 
and evolution of miasmal exhalations, there is no reason why the 
epidemic form of the disease should not be assigned to the same or 
similar agencies acting more extensively, in consequence of a uni- 
versal state of predisposition brought about by a peculiar, insensible, 
and unfathomable condition of the atmosphere. The diffusion of the 
disease over large tracts of country ; its prevalence at diversified sea- 
sons of the year, under diversified conditions of the sensible qualities 
of the atmosphere ; its visiting with equal force localities of different 
or even opposite characters and conditions ; its appearing, even at 
sea, far beyond the reach of any possible source of exhalation ; are 
inimical to the theory of its miasmal origin ; while the argument 

1 Stevens on the Blood, 138. 

2 See a communication on " The Bites of Venomous Serpents," by Dr. E. Hallo- 
well, in Trans, of Philad. Col. of Phys. i. N. S. 394. 



352 PNEUMONIA AND 

derived from the circumstance of the impossibility of discovering 
an evident cause to account for epidemic pneumonia is met by the 
fact already referred to, that sporadic cases, which it would be next 
to an absurdity to attribute to malaria, spring up without its being 
possible to trace them to any evident cause. At any rate, if the 
morbid agent giving rise to this and the preceding form of disease 
must really be viewed as nothing more than a species of malaria, 
that malaria can bear no analogy to the one producing autumnal 
fever. More likely is it that the cause of diffusion of the disease is 
meteorological, and assimilable to the terrestrial fluids of electricity 
and magnetism, and that its operation is limited to predisposing the 
system to be acted upon by other agencies. 

Dr. Merrill, to whose Essay attention has been especially called, 
disclaims, as we have seen, the disposition to deny that pneumonia 
sometimes appears as an idiopathic affection — a form of the disease 
which he seems never to have encountered in his practice, and only 
admits, because, to use his own language, such is the result of ob- 
servations made by others, who are certainly not less qualified to 
form a correct judgment in the premises. Even while upholding 
his favourite theory respecting the supposed connection between 
that disease and periodic fever, he regards the former, wheresoever it 
may appear, and whatsoever form it may assume, as being excited 
into action, or, in other words, as requiring for its development, the 
agency of the sudden transitions of temperature which occur on the 
approach of winter. Entertaining such views on these subjects; 
recognizing as a well-established fact the existence of an idiopathic 
form of the disease, distinct from that which he supposes prevails 
most generally — sometimes sporadically and frequently as an epi- 
demic — he will not refuse to acknowledge what, indeed, as w*e have 
seen, experience establishes beyond the possibility of doubt, that in 
northern latitudes and in elevated situations, where malarial fevers 
do not occur at all, or, if they do, show themselves only during a 
limited portion of the year, and are cut short by the intervention of 
frost ; where, therefore, the cause producing them is never evolved, 
or, being so, is destroyed on the approach of winter ; and where, as 
a consequence, pneumonia cannot be regarded as the offspring of 
that cause ; — this disease, which prevails in such localities at all sea- 
sons of the year, and is more particularly rife under circumstances 
perfectly incompatible with the development of febrile diseases, 
must necessarily be referred to the atmospheric influences above 



AUTUMNAL FEVERS. 353 

enumerated. We must presume, also, that he will not refuse to 
regard the idiopathic form of pneumonia, when it occurs in truly 
miasmatic regions, whether in the south, the north, the east, or the 
west, as the offspring of a cause differing from that giving rise to 
periodic fevers, and with these to that form of the disease which he 
views as closely connected or identical with the latter ; which cause 
cannot be other than the atmospheric influences which, as we have 
seen, produce inflammation of the lungs elsewhere, and, according 
to his own saying, is necessary to excite into being the sympto- 
matic form. The inference is inevitable ; for, were the cause not 
acknowledged to be of a different character, there would be no 
ground upon which to establish the distinction between an idiopa- 
thic and a symptomatiaibrm of pneumonia. 

Now, if the disease is thus viewed as arising from the agency of a 
distinct cause — often in tlfese and in northern latitudes, and some- 
times in the south and malarial districts generally; if, at the same 
time, it is acknowledged (if not in actual words, at least by implica- 
tion) that, were it not for this cause — i. e. the sudden transitions of 
temperature which occur at the approach of winter — the thoracic 
viscera would not, even in the symptomatic form of the disease, 
be called upon to bear the burden of local disease, and would escape 
risk of inflammation ; and if, besides, while such views are expressed, 
we are told that " the pneumonias which prevail in this country 
generally — sometimes sporadically and frequently as an epidemic 
— are really and substantially nothing more than a peculiar form 
of remittent and intermittent fevers," it must follow that such 
pneumonias are the result of the cause which produces these 
fevers, and which we may presume Dr. Merrill regards as different 
from that giving rise to what he holds to be the idiopathic form 
of the disease. Here, then, we find the same causes — atmospheric 
influences — officiating in some cases as the efficient and sine qua 
non agents in the production of the disease, and in others acting 
simply by promoting the development of the disease, the founda- 
tion of which had been laid by another and very different patho- 
genic influence. But, more than this ; we find the same disease — 
for we are not informed of the existence of any symptomatological 
or pathological difference between the two supposed forms of 
pneumonia — ascribed, as already mentioned, to two distinct classes 
of causes ; atmospheric vicissitudes on the one hand, and the pecu- 
liar agent, whatever this may be, which gives rise to periodic fever, 
23 



354 PNEUMONIA AND 

\ 

on the other. The reader can scarcely fail to see that this mode 
of proceeding does not accord with the canon laws of that system 
of philosophy of which we hear so much, and by which it is to 
be hoped all medical inquirers are guided; for that philosophy 
teaches the impropriety of referring a specific effect to more than 
one cause. In the present instance, it would lead us to conclude 
that, since the idiopathic pneumonia of the south is admitted to 
arise from causes distinct from those that produce periodic or 
autumnal fever; since the same disease undoubtedly arises very 
frequently, not to say universally, from such causes in the north 
and elsewhere ; and since, in the south, the agency of the former is 
essential to its manifestation, even when the causes of fevers are 
supposed to be instrumental in its production, there can be no rea- 
son for attributing pulmonary inflammatioD, when it appears in the 
southern section of this country, any more than when it shows 
itself in northern latitudes and in elevated positions, where autumnal 
fevers do not extend their sway, to a different morbific agent. 
Everywhere the same cause must produce the same effect, and a 
different effect must be produced by a different cause. Everywhere, 
therefore, the disease must arise from the same modifying agencies; 
and hence, if in some places it is due to atmospheric influences, 
there can be no propriety in lending our support to the idea that 
it arises elsewhere from the operation of agencies of a different 
kind. In other words, we must discard the theory which teaches 
that in the same place the disease occurs sometimes from the influ- 
ence of one cause, at other times from that of another ; and that the 
same influences — sudden transitions of temperature, and the like — 
act in some instances as an efficient cause, and in others lower 
themselves to the secondary office of exciting into action an inflam- 
mation produced by another agency. 

Autumnal fevers, if not produced like other zymotic diseases, are localized 
in certain places; not so pneumonia. — Let us examine the subject in an- 
other point of view, and acknowledge, for a moment, that remittent, 
intermittent, and yellow fevers, and other zymotic diseases more or 
less allied to them, are not the offspring of peculiar morbid poisons 
exhaled from the localities where they prevail; and are, so far as that 
goes, on a par with pneumonic inflammations ; I am not sure that the 
admission would afford much help to those whose opinions are under 
examination ; for it is impossible to shut our eyes to the fact, that 



AUTUMNAL FEVEES. 355 

the localization of those diseases takes place only where certain 
peculiar combinations of materials appertaining to the soil, or 
which have found their way there accidentally or otherwise, exist. 
Bearing this in mind, we arrive at once at the conclusion, that 
the real cause, whatsoever it may be, meets there certain agencies 
which so modify the system as to render it liable to their morbid 
impress. In a word, what many regard as the active and effi- 
cient cause of those diseases, may, after all, be only a predisposing 
agent. If this be correct, autumnal and periodic fevers are, in that 
respect, on an equal footing with other zymotic diseases arising 
from specific ferments or poisons. Every one knows that while 
Asiatic cholera and the febrile exanthemata are never produced by 
the malarial exhalations evolved from foul localities or marshy 
surfaces ; while typhus and typhoid fevers are, as it is said, seldom 
the offspring of the former, and certainly never of the latter; while 
none of these diseases are occasioned by the ingestion of putrescent 
food, by the use of foul water, by imperfect ventilation, by starva- 
tion, by excessive muscular exertions, by the intemperate use of 
alcoholic liquors, and the like ; and while, with the exception, per- 
haps, of typhus, they do not arise from the effluvia proceeding from 
the human .body — particularly the lungs and skin — and consisting 
of the effete and highly putrescent matter mingled with the air or 
perspiration — it is a notorious fact, that they are principally rife in 
situations where such influences operate, and strike with greater 
violence, malignancy, and fatality among individuals exposed to 
their baneful effects. This is true, whether the disease be the pro- 
duct of a zymotic poison floating in the atmosphere, and independ- 
ent for its development of any organic process, as Asiatic cholera ; 
or whether it arises from a poison formed in the system and trans- 
missible from one individual to another through means of contact, 
or the medium of the atmosphere ; or whether, again, it is due to 
a particular poison proceeding from external sources of animal or 
vegetable decomposition, or from the result of a morbific condition 
of the system, as is the case, perhaps, with puerperal complaints, 
erysipelas, and surgical fever. 

It will only be necessary to open the records of cholera in all the 
countries it has visited, and especially in England, where the sub- 
ject has been investigated with greater attention than elsewhere, or 
of typhus or typhoid fevers, to be perfectly satisfied that, where the 
predisposing influences in question exist, there these diseases rage 



356 PNEUMONIA AND 

with the greatest violence. Indeed, as Dr. Grainger well remarks, 
before the outbreak of any epidemic, knowing where the predis- 
posing causes are rife, physicians can foretell the precise localities 
where it will occur ; nay, even name the alley, or point to the exact 
house that will suffer. 1 

Now admitting, as already remarked, that autumnal fevers, of all 
possible grades, are to be placed in the same category with the 
diseases mentioned; admitting that the same relationship exists 
between them and the morbid influences above specified, as between 
these and the other forms of zymotic complaints ; in other words, 
admitting, that not only intemperance, starvation, imperfect ventila- 
tion, putrescent food, foul water, but marsh miasmata and malaria 
generally, are restricted in their agency to the predisposing of the 
system to receive the morbid impressions of the efficient cause, it 
would not be the less true, that there exists a wide difference in 
that respect between those fevers and pneumonia. 

We have already seen that the latter disease, so far from being 
necessarily more frequent in malarious countries, has often, if not 
generally, been noticed to prevail less extensively there than in 
places differently circumstanced. Malaria, therefore, cannot be re- 
garded as its predisposing cause. If we turn to our wharves, courts, 
alleys, and the habitations of the poor, where sources of foul exha- 
lations, of every kind imaginable, are abundant, we do not find that 
pneumonia is more generally noted there than in other localities. 
Nor do we find that putrescent food, foul water, imperfect ventila- 
tion, starvation, intemperance, or concentrated human effluvia, exer- 
cise an important influence in localizing the disease and increasing 
its prevalence. These morbid agencies, and a few others which 
predispose to fevers, may have an injurious effect as regards pneu- 
monia ; they may, by lowering the tone of the system, and diminish- 
ing the power of the latter to resist the force of the morbid impres- 
sion, increase, to a certain extent, the danger of the attack ; in the 
same way as do advanced age and other causes of constitutional 
prostration. But the injurious effect, so far as regards predisposi- 
tion, is comparatively restricted in reference to pneumonia ; while in 
regard to fevers and other zymotic diseases, it is strikingly great. 
Pneumonia attacks, and, the force of the constitution being the 

1 Influence of Noxious Effluvia on the Origin and Propagation of Epidemic Diseases. 
Quoted by Med. Exam. April, 1853, p. 253. 



AUTUMNAL FEVERS. 357 

same, is equally fatal among all classes of society, the rich and the 
poor. We possess no authentic statements calculated to show that 
the latter are more prone to the disease than the former ; for, if 
among the rich thoracic inflammations have occasionally been 
found to prevail less extensively, the explanation may be readily 
found in the fact that they are less exposed, not to the modi- 
fying influences above mentioned, which, as we have seen, predis- 
pose to fevers and zymotic complaints generally, but to the injuri- 
ous impression of the ordinary exciting causes of the disease. In a 
word, autumnal and periodic fevers of all grades — supposing them 
not to be produced by malarial exhalations — are like other zymotic 
diseases, principally rife among individuals whose systems have 
been for a greater or less period of time under the depressing 
influence of such exhalations. These, like the rest of the recog- 
nized morbific influences mentioned, must, at the very least, be 
admitted, in accordance with that view of the matter, to act inju- 
riously by predisposing the system to the action of the disease; and 
when examined attentively, the effect will be found to be evidently 
accomplished, as Dr. Carpenter well remarks, by producing in the 
blood of the individual exposed to them an excess of those decom- 
posing organic compounds, which, as physiology teaches us, are 
always present in the circulating current, in minute proportion; 
being conveyed by it from the spots in which they are introduced, 
or in which they are generated, to the organs through which they 
are to be eliminated ; and an excess of which is manifestly produ- 
cible, either by the direct introduction of those matters from with- 
out, in the food or drink consumed, or in the air respired ; or by 
the production of them within the body, at a rate beyond that at 
which they are normally eliminated ; or by some obstacle to their 
elimination, which prevents the amount ordinarily originated from 
escaping at its normal rate through the usual outlets. 1 It would 
puzzle the most clairvoyant among the advocates of the hypothesis 
under examination, to discover and point out the existence of the 
most distant analogy in regard to the subject just mentioned, be- 
tween pneumonia and autumnal fevers ; for while the predisposing 
if not efficient causes of the latter are of the nature stated, and 
exercise their baneful influence in the way mentioned ; while for 
this reason those fevers establish their claims to take rank among 

1 Brit, and For. Med.-Clrir. Rev. Jan. 1853, p. 162. 



358 PNEUMONIA AND 

zymotic diseases ; pneumonia recognizes for its predisposing causes 
agencies of a very different character ; such as, instead of lowering 
the purity of the blood, tend to increase its vitality, and would, in 
the absence of a thousand other reasons, suffice to put a bar to the 
idea of placing the disease among the zymotics, and establishing a 
parallel between it and fevers. 

The opinion is incorrect, for it leads to the inference that the same 
cause produces diseases differing icidely in symptoms and anatomical 
characters. — Nor does it appear less certain that the theory, or more 
properly the hypothesis, under examination, is faulty in another 
point of view ; for while, as has been seen, it admits that the pneu- 
monia of the south, if not pneumonia generally, is in some instances 
an idiopathic affection, and hence arises from causes distinct from 
those to which, it is thought, the disease should, in the majority of 
cases, be referred ; in other words, while in accordance with that 
belief, inflammation of the lungs may be the offspring of two dif- 
ferent sets of causes, we are given to understand that from the same 
cause — malaria, according to some, and atmospheric influences, 
agreeably to others — there may and do arise various series of mor- 
bid phenomena, which, when examined, are found to bear no 
resemblance to each other, and which, consequently, medical ob- 
servers, from the days of Gralen, if not of Hippocrates, to our own, 
have, with scarcely an exception, regarded as essentially dissimilar. 
What diseases, indeed, in the long list of those flesh is heir to, differ 
more widely from each other than pneumonia and malarial fever ? 
Of the former, the seat is necessarily the substance of the lungs, 
with or without an implication of their covering and lining mem- 
brane, in which morbid changes are effected that need not to be 
specified here. "While this is the case with these organs and tis- 
sues, the contents of the abdominal and other cavities may, and do 
often remain unaffected to the last ; or if they become implicated at 
the outset, or during the course of the attack, the effect is generally 
due to causes independent of that which gave rise to the thoracic 
affection. When, in such cases, the inflammation of the lungs has 
been removed by proper means, or when, as not unfrequently hap- 
pens — witness the effects of homoeopathy — it subsides through the 
influence of the recuperative powers of the system, the fever by 
which it was accompanied disappears also, unless some other organ 
or tissue has taken on inflammation, and the latter keeps up febrile 



AUTUJtfNAL FEVERS. 359 

excitement ; or unless the case be complicated from the onset with 
some other complaint. This result could scarcely he looked for 
were the disease a constitutional one, caused by some general agency, 
and the local affection only a secondary effect superadded to the pri- 
mary complaint. So far from this, the fever in pneumonia is depend- 
ent on and inseparable from the pulmonary inflammation, the removal 
of which is necessarily followed by the cessation of the former. 

On the other hand, the febrile poison manifests an affinity for the 
abdominal viscera, which are affected to a greater or less extent in 
the large majority of cases. While doing this, it sometimes spreads 
its effects to the brain or its membranes ; which, however, are more 
frequently involved in a secondary than in a primary way. But 
whatsoever be the morbid impression produced on these organs, the 
poison does not injure the pulmonary tissues, for which it has no 
affinity — so far at least as to excite in them the inflammatory change. 
Even on the abdominal organs, it does not always excite true 
inflammation ; or when it does, the effect is felt by the mucous sur- 
faces and secretory organs, and not by the serous and parenchyma- 
tous structures. If these at any time, and in any case, become the 
seat 'of inflammation, the result is due to fortuitous circumstances, 
and does not constitute an essential part of the disease, which may. 
and does generally exist and run its course, to recovery or death, 
clothed in all its legitimate and characteristic colours, without ex- 
hibiting evidence of such an implication. Contrary to what occurs 
in pneumonia, when, in pure and uncomplicated cases of autumnal 
or periodic fevers, the physician succeeds in removing all the local 
inflammations which may exist, he must not be too sanguine about 
putting a stop to the fever itself; for the chances are a hundred to 
one that it will continue to run its course, uninfluenced in that 
respect by the cure of the local disease ; in the same way that the 
alligator's head, in the experiments of a distinguished physiologist 
of our country, continued to live — saw, winked, snapped, and even 
jumped — though deprived of its usual appendage, the body. 

Affinity of morbific and therapeutic agents for special organs not to 
be denied.— The fact of the affinity of deleterious agents for a par- 
ticular part, is not one of which a well-read and observant physician 
can be ignorant; it has been observed and admitted from time 
immemorial. More than a century ago, Borden, whose authority in 
matters of the sort will not be impugned, remarked : " All morbific 



360 PNEUMONIA AND 

miasms have their organs marked and predisposed for their germina- 
tion. It is in these organs that each miasm penetrates ; it is for them 
it has a special tendency ; the herpetic attacks the skin, the scrofulous 
the glands, the venereal the organs of generation. The poison of 
gout affects the whole nervous system, and is only developed in the 
articular membranes. Each imparts to the individual in whom it 
germinates peculiar modifications, often of a diseased kind, often also 
consisting of a particular manner of being, or a well-characterized 
temperament." 1 At a later period; Mr. Hunter stated, in language no 
less explicit, that " poisons take their different seats in the body as 
if they were allotted to them." In a word, such agents, when intro- 
duced into or applied to the sj^stem, do not produce their effects 
on all the organs or tissues indiscriminately. So far from this, 
each morbid or common poison, each article producing some phe- 
nomenon which links it, as to its effects, with other articles, gives 
rise to phenomena of a special character, and is often found to 
occasion lesions of specific organs. While putrid substances, 
when inhaled into the lungs, or thrown into the circulation, affect 
the gastro-intestinal surface, the subcarbonate of soda applied in 
the latter way disorganizes the thoracic viscera. The lungs be- 
come gorged with blood, which gushes out when incisions are made 
into their substance, and bloody fluid is effused into the pleura, 
while the tissues and organs of the abdominal cavity are found in 
their normal state. 2 The lungs are specially affected by the bichlo- 
rate of mercury ; the bronchiae attract and eliminate phosphorus ; 
the heart is affected by the upas antiar and digitalis ; the kidneys by 
cantharides, oil of turpentine, indigo, saffron, and nitrate of potash; 
the liver by verdigris ; the same or some other secretory organs are 
affected by mercury; the stomach by ipecacuanha, colchicum, and tar- 
tar emetic; the bowels and not the stomach by purgatives; the brain 
by opium ; the spinal marrow and nervous system by nux vomica 
and prussic acid ; the uterus by ergot ; the capillary system by eu- 
phorbium, &c. 3 

The advocates of the malarial origin of pneumonia, some of whom 
seem to have forgotten this power of affinity, would do well to bear 
these facts in mind: as also the pustules of smallpox; the cynanche 
and erythema, and kidney affections of scarlatina; the intestinal 

1 Borden, Analyse Med. du Sang, in Collected Works, 1011, 1012. 

2 Magendie on the Blood, 178, 183, 191, &c. 

3 See Blake, Sir Everard Home, Haller, Magenclie, Legallois, Gaspard, Simon, &c. 



AUTUMNAL FEVERS. 361 

ulcers of typhoid fever; the catarrh and eruption of measles; the 
rupia and periostitis of syphilis ; the SAVollen parotid of mumps ; the 
suppurating tumours of glanders ; and other similar local affections 
which present themselves daily to our observation. Let them do 
so ; and remember, at the same time, that " syphilis never produces 
ulcers in the ileum, scarlatina never causes iritis," and that " the 
causative poison of the one disease differs from the causative poison 
of the other, for on the selfsame subject it produces different 
effects," 1 and they will, perhaps, feel less reluctance in admitting 
that the malarial poison exercises its specific effects on the mucous 
tissue of the gastro -intestinal apparatus, and on the spleen, and 
leaves the pulmonary organs uninjured. 2 

Distinctive symptoms and pathological conditions different in pneu- 
monia and malarial fevers. — In all that precedes, I am borne out by 
the symptoms observed during life in the two diseases. In the 
former (pneumonia), the phenomena indicate the existence of acute 
inflammation, and greater or less congestion of the organ affected ; 
while the blood exhibits changes, as well in regard to the propor- 
tion of its fibrin and other elements, as to its physical characters, 
which not only prove it to differ considerably from the healthy 
fluid, but assimilate the disease to a class very unlike the pyrexias. 
It need scarcely be remarked, that in all inflammations the blood is 
in what has been denominated a state of hyperinosis. It contains 
more fibrin than in the normal state — 5 or 6 parts in 1,000, instead 
of 2 or 3 — while the corpuscles decrease in proportion to the excess 
of the fibrin, from about 141.1 in 1,000 to about 128.0. The fatty 
matter also is increased ; and, as a consequence of all these changes, 
the whole solid residue is diminished. The blood coagulates more 
slowly than in the normal state ; the clot is not usually small, but 
very firm and consistent, and does not break up for a considerable 

1 Simon's Lectures on Gen. Path. 191. 

2 "If we were to attempt to explain how it happens that particular organs are 
affected rather than others, we must do so upon the most crude hypothesis. We must, 
therefore, as well observed by Mr. Piorry, accept the facts, without being able to 
account for them. Chemists cannot tell you why carbon has more affinity for oxygen 
than for azote ; nor can physicians tell why cantharides, taken into the blood, act 
rather upon the kidneys than upon the brain. Whether we regard medicines or 
poisons, morbid secretions, excretions, contagions, or miasmata, absorbed into the 
blood, these observations are equally applicable." — AnceU's Lectures on the Blood. 
Lancet, 1840, p. 781. 



362 PNEUMONIA AND 

time. It is almost invariably covered with a buffy coat, which is 
firm, tough, and intimately connected with the clot ; its edge is often 
turned upwards and its surface uneven. If the clot be small, the 
buffy coat and the surface of the clot are more or less cupped, and 
the serum is of a pure lemon colour, not tinged red. When whip- 
ped, the fibrin separates in thicker and more solid masses than in 
ordinary blood. After the removal of the fibrin the corpuscles 
quickly sink, and frequently occupy only one-fourth of the whole 
fluid, while in healthy blood they sink very imperfectly, or not at all. 
The blood has always an alkaline reaction, and is of a higher tem- 
perature than in the ordinary state. All these changes are propor- 
tionate to the degree of the inflammation. 1 Such is the condition 
of the blood in the phlegmasia? generally. In pneumonia, the state 
of hyper inosis is even more decided than in other diseases of that 
class, as the blood retains its heat longer ; the clot is below the 
ordinary size, and very consistent, and does not break down for a 
considerable time. It admits, of being sliced, and the sections retain 
their consistency for some time. Its surface is covered with the 
buffy coat, and is more or less cupped. The serum is of a pure 
yellow colour. The quantity of solid constituents is usually less 
than in healthy blood. The proportion of fibrin increases and 
varies, according to Anclral and Gravarret, from 4 to 10.5 in 1,000 
parts, with a mean (in 58 experiments) of 7.5 ; from 5.919 to 12.726, 
according to Eindskopf, and 3.4 to 9.15, with a mean of 6, accord- 
ing to Simon; while the blood-corpuscles, according to the first 
experimenters, amount to from 83.2 to 137, with a mean of 114.1 ; 
and, according to Simon, to as little as from 36 to 78, 2 If other 
symptoms present themselves, or if the blood assumes a different 
appearance, these results are due to complications; they do not 
constitute a necessary link in the chain of phenomena imparting an 
individuality to the disease, and are not, therefore, pathognomic. 

Examine we now the distinctive sjmrptoms of periodic and 
autumnal fevers — (applying to those terms their most enlarged 
sense) — those symptoms which alone enable us to diagnose those 
fevers — which impart to them their individualhvy, and assign them 
an independent position in every nosological arrangement, and we 
shall not discover one calculated to lead us, for a moment, to the 

1 Geo. Tolli, Bicherche et Esperienze, sul sangue umano Annali Universali, cxiii. 
333; Simon, Animal Chem. i. 250; T. W. Jones, Ediub. Journ. Ixxvi. 108. 

2 Simon, op. cit. i. 258, 259, 2G2. 



AUTUMNAL FEVEKS. 363 

supposition that the lungs are the seat of inflammation or acnte 
congestion. So far from it, indeed, respiration is less impaired in 
the early stage of those diseases than most of the other great 
functions. When it becomes deranged, the effect is of a nervous 
character, or the result of the inability of the blood-corpuscles to 
carry oxygen ; and physical exploration usually indicates no 
important morbid change in the pulmonary tissue, and when it 
does — as more frequently occurs during the latter stage of malig- 
nant cases — the signs are those of passive congestion. Bronchitis, 
except in a very few cases, is not developed, and when so, is usually 
traced to its legitimate causes, and need not be laid to the score of 
the malarial poison. At the same time, all the symptoms observed 
— all, I ^repeat, that are pathognomonic — point most usually to the 
stomach, bowels, liver, and spleen, sometimes to the brain, as being 
the organs principally implicated. Sometimes they indicate the exist- 
ence of acute inflammation in one or more of these — more gene- 
rally of simple congestion, and more frequently still of functional 
disorder of the former, with or without congestion of the latter — 
of the spleen particularly — which in some of the pyrexiae bears a 
large share of the brunt of the disease. The blood at the same 
time either exhibits, as in some of the milder forms of the disease 
— simple intermittents, for example — or in the early stages of other 
forms of a more severe character, little or no change from its nor- 
mal state ; or manifests in the more advanced stage of these, and 
even in some cases of intermittents, as well as in the early stages of 
the other, and particularly in the malignant grades, alterations in 
its chemical composition and physical characters the very reverse 
of those observed in pneumonia and the phlegmasia^ generally. 
The fluid is in that state which has received the denomination of 
hypinosis. The fibrin is frequently less than in healthy blood, or 
if it amounts to the normal quantity, its proportion to the blood- 
corpuscles is less than is found in a state of health (2.1 : 110, Simon, 
or 3 : 110, Lecanu) ; the quantity of corpuscles is either absolutely 
increased, or their proportion to the fibrin is larger than in the 
healthy state ; and, in addition, the quantity of solid constituents is 
also frequently larger than in the normal fluid. 

The clot, though sometimes small, is more commonly the reverse. 
It is soft, diffluent, and of a dark, almost red colour. Occasionally, 
indeed, no clot is formed. The buffy coat is seldom seen, and when 
this is the case, is thin and soft, and forms a gelatinous parti-coloured 



364 PNEUMONIA AND 

deposit on the clot. The serum is sometimes of a deep yellow 
tinge from the colouring matter of the bile ; or red, from blood- 
red corpuscles in suspension. The blood has always an alkaline 
reaction. 1 In some forms of the disease, it even approaches that 
state denominated spanasmia ; it is watery, very poor in fibrin, and 
of a dark colour. If any clot be formed, it is diffluent and very 
soft, the serum is frequently of a dark yellow or brown-red colour ; 
partly from the colouring matter of the bile, and partly from dis- 
solved hsematoglobulin. It possesses a very peculiar smell, which 
not improbably depends on a volatile salt of ammonia. 2 These 
changes, which can be artificially produced by the introduction of 
putrid substances into the circulation, are observed in a more or 
less marked manner, not only in malarial remittents, sometimes in 
intermittents, but also in typhoid, typhus, relapsing, yellow, and 
pestilential fevers, as well as in a variety of other diseases arising 
from the action of morbid poisons. 

The fevers of this country, from the simple intermittent to the 
malignant yellow, have exhibited them to a greater or less extent. 
As regards the latter form of the disease, the altered condition of 
the blood has been noticed by Lining and Moultrie, and, since 
them, by Bush, Deveze, Nassy, Physick, Cathrall, Brown, Gurrie, 
Caldwell, Miller, Drysdale, E. H. Smith, Potter, Gros, Cartwright, 
Kelly, Nott, S. Jackson, Stone, and by almost every other writer 
on the subject. It is, indeed, a fact of so notorious a character, as 
not to call for any special illustration in this place. Not less evi- 
dent, though perhaps not so distinctly marked, are the changes in 
question on the milder forms of the disease. They were noticed by 
Dr. John Mitchell, in the fever he observed in Yirginia in 1737, 
1741, 42, and which was improperly denominated yellow fever. 3 
Since then, attention has been called to them in a more or less 
pointed manner by Drs. Daniels, Dickson, Drake, Stewardson, and 
other American writers, as also by Dr. Stevens, who had an oppor- 

1 Simon, Animal Chemistry, i. 287, 301, 302. 

2 Ibid. i. 319 ; ibid. Appendix, ii. 510. 

Salvagnoli examined the blood of four persons actually labouring under, or who 
had just recovered from intermittent fever, and were living in a malarious district. 
He found that it exhibited a notable diminution of albumen and fatty matter, and that 
the phosphates had almost entirely disappeared. It contained, however, a large 
quantity of cholesterin. It is remarked that the biliary secretion of those living in 
such districts has been previously noticed to be rich in cholesterin. Saggio illustra- 
tive dclla Statistica Meclica della Maremme Toscane, 66. 

3 Med. and Philos. Register, iv. 188. 



AUTUMNAL FEVERS. 365 

tunity, during his visit to this country, to observe our lake and 
marsh fevers. It would be useless to enter at large on the sub- 
ject ; and I shall content myself with making room only for a brief 
summary of observations made on the subject by Dr. Frick of Balti- 
more. This writer examined twelve cases of autumnal fever. Of 
these, five were of the remittent, and the balance of the intermittent 
type. In two of those cases — one of the intermittents, and one of the 
remittents, the disease assumed the congestive form. In four classed 
as remittents, the proportion of the fibrin was above the usual 
standard. In the fifth case of that class, the disease was of three 
weeks' duration, and all the elements of the blood, except the chlo- 
rides and the phosphates, were below their natural standard. In 
five of the cases of intermittent fever out of seven, the fibrin was 
below the average quantity. Of the two exceptional cases, one was 
complicated with ascites, and oedema of the lower extremities, coming 
on as an acute affection, and being preceded by a chill; and the 
other was complicated with pneumonia at the summit of the lung. 
The increase of fibrine in the four cases of remittents, as above 
mentioned, was due to the superaddition of gastro-duodenitis to the 
original disease. The blood-globules in the remittent form were, 
as is the case in the pyrexia generally, in all the instances except 
the one above alluded to, increased. 1 

The same changes have been noticed not only as regards typhus, 
typhoid, and relapsing fevers, but common malarial diseases, in 
England, France, Ireland, Scotland, Italy, and Germany, as well as 
in the West Indies, Algeria, Western Africa, &c, as the reader may 
readily find by referring to the writings of Huxham, Cleghorn, 
Sarcone, E. Armstrong, Evans, Tweedie, Cormack, Stevens, Boyle, 
J. Davy, Andral and Gravarret, Leonard and Foley, Clanny, Burne, 
Stokes, Eeid, Stoker, Haspel, Boudin, McWilliams, Jennings, J. 
Armstrong, Lecanu, Cozzi, Salvagnoli, F. Home, and Clot-Bey, to 
say nothing of the very large majority of authors who have treated 
of the yellow fever of Spain and tropical regions. 

In the same way that in pneumonia we find that a condition of 
blood, more or less approximating to the one mentioned above, 
indicates the complication of a typhoid diathesis, or of a strong mala- 
rial taint, so in fevers arising from the latter cause, or in the pyrexias 

1 Of the Relative Proportions of the different Organic and Inorganic Elements of 
the Blood in different Diseases, Am. J. xv. (X. S.) 29. 



366 PNEUMONIA AND 

generally, the excess of fibrin, and its greater proportion relatively 
to the blood-corpuscles, indicates the existence of a phlegmasia in 
addition to, but forming no essential part of, the disease. 

These changes in the appearance of the blood are noticed not 
only during the attack of malarial fever ; they have been observed 
even in individuals in apparent health residing in malarial regions, 
and especially during the prevalence of an epidemic of remittent, 
intermittent, or yellow fever; and, indeed, of many other forms 
of zymotic diseases. The late Dr. John Mitchell, of "Virginia, in 
the account he left us of the so-called yellow fever which prevailed 
in some parts of that State about the middle of the last century, 
remarks : " Even those who are bled after a received contagion 
before the fever is formed, have a thin, dissolved, florid blood, even 
in winter. This was the constant state of the blood in about thirty 
or forty whom I have known to have been bled at all seasons of 
the year." 1 Alluding to the fever of Baltimore in 1800, Dr. Potter 
says: "To ascertain the appearance of the blood in subjects appa- 
rently in good health, I drew it from five persons who had lived, 
during the whole season, in the most infected parts of the city, who 
were, in every external appearance and inward feeling, in perfect 
health. The appearance of the blood could not be distinguished 
from that of those who laboured under the most inveterate grades 
of the disease. A young gentleman having returned from the 
western part of Pennsylvania, on the 10th of September, in good 
health, I drew a few ounces of blood from a vein on that day ; it 
discovered no deviation from that of other healthy persons. He 
remained in my family till the 26th of the month, and, on that day, 
I repeated the bloodletting. The serum had assumed a deep yellow 
hue, and a copious precipitate of red globules had fallen to the bot- 
tom of the receiving vessel." 2 Dr. Archer, of Norfolk, has also 
noticed the same fact, stating, as an evidence of the extent to which 
the predisposing causes of this fever operated, that the blood taken 
from healthy persons generally exhibited changes which were easily 
discernible as it trickled down the sides of the basin. These were 
pretty regularly increased as you approached the infected district. 3 

The same fact is confirmed in regard to malarial fevers of lower 
grades by the results of observations made in the Tuscan Maremma 

1 Med. and Philos. Reg. iv. 188. 2 A Memoir on Contagion, 54. 

" Hist, of the Ycl. Fev. of Norfolk in 1821, Med. Rec. y. 68. 



AUTUMNAL FEVEES. 367 

and in the miasmatic districts of this country. " So great and so con- 
stant is the difference," says a high authority in reference to the for- 
mer, "that, from the physical examination of the blood only, almost 
without error, the physician may judge if the patient resides con- 
stantly in an unhealthy atmosphere, and if the liver and spleen have 
been altered." 1 During his visit to the United States, Dr. Stevens saw 
much of our lake fever, especially in the Genesee country. In the 
months of September and October, 1830 — the sickly period — he bled 
several individuals who resided in some of the infected localities, but 
had not yet been attacked with the fever. In every one of these, the 
blood invariably presented the same diseased appearance which he 
had often observed in those who resided near to swampy situations 
in the West Indies. It was very dark in colour, and evidently 
deranged in its physical appearance, while the serum which sepa- 
rated, in place of being clear, had a muddy or brown colour, and, 
in some cases, an oily appearance. In fact, Dr. Stevens did not 
meet with even one intelligent practitioner in that country, who 
was not aware of the fact that the blood of the inhabitants, during 
the sickly months, is very different from that of those individuals 
who arrive from healthy situations;- whilst even in those who re- 
side in the most unhealthy situations, and who have not yet had the 
fever, it is not only dark in colour, but evidently so much diseased 
in its properties as to be very unlike the blood in health. 2 

To this it may be added that, in pneumonia, the blood preserves 
its ordinary and specific odorous exhalation; while in diseases 
arising from the action of the malarial poison — in some forms of 
them at least — the fluid acquires a peculiar odour not encountered 
in other complaints. In some forms of fever — typhus, plague, and 
yellow fever — the blood possesses a very peculiar smell, which pro- 
bably differs in each disease, and is produced by a volatile salt of 
ammonia. 3 Dr. Stevens, in speaking of the condition of the blood 
in what he calls the African typhus, remarks that, "when first 
drawn, it has a peculiar smell." 4 And Dr. Eush, in his account of 
the epidemic of 1794, mentions that a similar statement was made 
to him by a. German bleeder, whose experience in 1793 was very 
ample, and affirmed he could distinguish a yellow fever from all 
other forms of fever. " From the certainty of his decision in one 

1 Saggio illustrative) le Tavole della Statistica Medico, della Marerame Toscane,.211. 

2 On the Blood, 216. 3 Simon, op, cit. i. 319, 320. 
4 On the Blood, 219. 



368 PNEUMONIA AND 

case which came under my notice," adds Dr. Rush, "before a sus- 
picion had taken place of the fever being in the city, I am disposed 
to believe that there is a foundation for his remark." 1 I may add, 
that Mr. Ripperger, a highly respectable bleeder of this city, who 
has gone through all our epidemics from 1793 to the present day, 
and, during that time — thanks to the system long in vogue— shed 
more blood than any ten men living or dead, has confirmed to me 
the above statement of Dr. Rush's authority. And why should it 
not be so? It is known, particularly since the experiments of 
Barruel, that the blood of every vertebrate animal has in it an 
odoriferous principle, identical in all the individuals of the same 
species, and similar to the odour of the cutaneous transpiration, or 
to that part of it which gives to each animal its characteristic smell. 
We know, also, that according to the principle laid down by Bar- 
ruel, and more or less acknowledged by other chemists, that the 
blood of each individual exhales an odour closely resembling that 
of the cutaneous perspiration, and so peculiar that the species, and 
even the sex of any animal from whom a given quantity of blood 
has been drawn, may be determined hj it. 2 It is known, also, that 
certain poisonous and other substances — ether, hydrocyanic acid, 
camphor, and alcohol, which, when taken into the system, find their 
way into the circulation, impart peculiar odours to the blood; and 
when we combine these various circumstances together, we cannot 
help perceiving that the malarial poison, when absorbed, may so 
modify that fluid as to produce analogous effects. 

Are we not justified in explaining, by the changes which occur 
in the blood of individuals affected with autumnal and other fevers, 
many of the phenomena which present themselves in the course of 
those diseases? On the subject of anaemia and scorbutic attacks, 
there can be but little difficulty. In reference to interna ittents, a 
writer in the Dublin Journal (vii. 219) says, and his remarks apply 
equally well to other fevers : " The diminution of the globules 
(probably also a diminution of their power of absorbing oxygen) 
explains the prostration of the entire constitution and the occasional 
disturbances of the circulation. The diminution of the fibrin ex- 
plains the ecchymosis on the skin and in the cellular tissues, the 
bleeding from the nose and gums, the gangrene of the mouth which 
sometimes occurs, and the pain in the limbs. The diminution of 

1 Works, iii. 228. 2 Brit anc i For. Rev. xi. 226. 



AUTUMNAL FEVERS. 369 

the albumen explains the hydropsical swellings, anasarca, ascites, 
and probably also the watery diarrhoea, which always closes the 
last scenes of persons weakened by fever." 

Another writer remarks: " The first action of the poison is appa- 
rently upon the functions of the blood; those are impaired, or, in 
peracute cases, cease altogether. The functions of the blood are, 
first, to maintain the activity of the nervous and muscular systems ; 
and, secondly, to supply the materials for the molecular changes 
constantly going on in the tissues. It is essential to this being 
properly performed that the blood-corpuscles be in a fit condition 
to carry oxygen, and it would appear from the symptoms which 
mark every stage of fever, that this function of the corpuscles is 
impaired from the first. This is indicated by the hesoin de respirer 
developed in the premonitory stage; the sensation and condition of 
the respiratory organs are precisely the same as if their capacity 
had been diminished, and due aeration of the blood thus prevented. 
The patient takes many forced inspirations, sighs, or gasps, and the 
breathing is quickened on the least exertion. The haemato-globuline 
is changed also, for the skin assumes a peculiarly pale, sallow, and 
unhealthy look. The function of the nervous system is impaired 
in consequence of these changes in the blood, namely, the changes 
effected by the poison and the defective oxj^genation — hence lassi- 
tude and weariness, disturbed functions, or congestion of some or 
all of the viscera, and a lower temperature." 1 

From all that precedes, it follows that in uncomplicated pneu- 
monia, we have febrile reaction attended necessarily with, and 
depending on, local inflammation of the lungs — which fever is ac- 
companied with an increase of fibrin in the blood. In the autumnal 
(as also in other) pyrexiae we have likewise fever; but unlike what 
occurs in the former, this fever is not necessarily attended with 
symptoms of local inflammation, and is characterized by a defibrin- 
ated condition of the blood. This defibrinated condition of the 
blood, and the symptoms accompanying it, many of which it serves 
to explain, are analogous to, or resemble, those produced by the 
introduction of putrid or poisonous matters into the circulation ; 
whilst the opposite condition of the same fluid in pneumonia serves 
to explain the symptoms by which this disease is attended, and would 
be totally incapable of accounting for those that are characteristic 

1 Brit, and For. Med.-Chir. Rev. iii. 95, 96. 

24 



370 PNEUMONIA AND 

of idiopathic fever ; at the same time that it could not in any con- 
tingency be the result of a poisonous agent thrown into the circula- 
tion. Can any one, with such facts before him, seeing an increase 
of fibrin on the one hand, and a diminution of the same element 
on the other, unite in sentiment with those who regard the two 
diseases as pathologically identical, and maintain with them that 
pneumonia is really and substantially nothing more than a peculiar 
form of remittent and intermittent fever? In other words, can he 
be persuaded that a peculiar disease, characterized by a particular 
condition of the blood, and depending for its existence on the local 
inflammation of a special organ, is only a different form of another 
disease, marked by a diametrically opposite condition of that fluid, 
and not necessarily connected with the inflammation of that, or any 
other organ ? 

Odour of the surface peculiar in some malarial diseases ; not so in 
pneumonia. — Nor do we find that the two diseases approximate 
much more closely in respect to the odour emitted by the sick. 
In pneumonia, as in other kindred inflammations, the odour, apart 
from that which accompanies ordinary perspiration consequent on, 
or occurring during or at the close of the stage of febrile excite- 
ment — more frequently at the period of crisis — or from that which 
depends on the peculiar complexion of the patient, or the particular 
idiosyncrasy he may possess, presents nothing unusual, and apper- 
taining in a special manner to the disease ; — nothing which is not seen 
every day in other and dissimilar febrile complaints — nothing which 
may serve to impart to the case a particular pathogenic character. 
If this does not hold good in all cases, the exceptions occur principally 
in the typhoid form of the disease, or when the case, though not ori- 
ginally of that kind, falls into a low malignant condition ; or they 
occur when the pneumonia is complicated ah initio with some dis- 
ease in which the phenomenon commonly shows itself; but, in such 
instances, the fetid odour emitted belongs to that typhoid condition, 
or to the other complaint superadded to the thoracic inflamma- 
tion, and not to the latter itself. If, now, we pass from this disease 
to the malarial pyrexias, we shall find that in these, particularly in 
the advanced stages, and in the malignant forms, the odour of the 
surface constitutes frequently a prominent, and, as it were, a cha- 
racteristic symptom, which, considering the connection between the 
odour of the blood and that of the skin in the state of health, may 



AUTUMNAL FEVEKS. 371 

be presumed to arise from that imparted to the circulating fluid 
by the malarial poison. We may even go so far as to aver, that 
each variety of malarial fevers presents something peculiar in that 
respect, which, while enabling the pathologist to distinguish it 
from pneumonia and other true phlegmasia?, affords him the means 
of pointing out, to a certain extent, at least, the particular nature of 
the case under examination, or the class to which it belongs. Speak- 
ing of the second period of the Niger fever, Dr. McWilliams says : 
" The principal complaint at this period was from the odour of the , 
perspiration, particularly in those cases that subsequently proved 
fatal. I was not sensible of this peculiarity in the smell of the per- 
spiration in my own case, but I perceived it very distinctly in 
several others." 1 In the bilious remittent fevers of Ceylon and the 
West Indies, a peculiar smell emitted by the sick is alluded to by 
Dr. Millingen, and other writers. 2 

In the yellow fever, a peculiar odour is described as being of still 
more common occurrence. I am aware that many writers on the dis- 
ease as it shows itself in tropical and temperate regions, have taken no 
notice of this symptom ; and that there are not wanting those who 
have expressed doubts as to its occurrence, or even denied it alto- 
gether. Dr. Townsend, for example, in his account of the epidemic 
of New York in 1822, says that there was not, at any time, as far 
as his experience goes, a foul cadaverous effluvium from the body, 
" a symptom so peculiarly characteristic of typhus, with which yel- 
low fever, however, ought not to be confounded. On the contrary, 
in a majority of cases, everything about the patient seemed perfectly 
inodorous, and for hours after death." 3 Dr. Tully also, in speaking of 
the fever of Middletown, Conn., in 1820, informs us that, in general, 
there was but little fetor before death, and even the usual febrile 
smell was not, in many instances, perceptible. 4 

But whatever may have been the case in New York and Middle- 
town, at the periods in question, and in other instances that might, 
if necessary, be mentioned, and however true it may be that from 
these facts and the silence of several writers on the subject, we may 
infer that the surface of the body in the yellow fever does not 

1 Op. cit. 133. 

2 Second Report of London Board of Health, 364 ; James Clark, Fever of Domi- 
nica, 20. 

3 Op. cit. 1G5. 

4 Essays on Fevers and other Medical Subjects, &c. 30. 



372 PNEUMONIA AND 

invariably emit an odour of a peculiar kind; yet facts sufficient may 
be gathered from the writings on this disease, in both temperate and 
tropical regions, to bear me out in what is here stated, and to show, 
not only that the symptom in question occurs often, but does so 
under circumstances calculated to induce us to view it as pathog- 
nomonic of the fever generally. I cannot doubt having recognized 
a peculiar and offensive odour about the persons of individuals 
affected with this disease ; and I think it has enabled me, in some 
instances, to establish a correct diagnosis. In one or two cases 
the smell was highly offensive. It has been noticed in all our 
epidemics. Dr. Deveze 1 speaks of it as of frequent occurrence 
in the latter stages of the disease, and designates it as fetid — une 
odeur infecte. Dr. Eush 2 states that, in 1793, the sweats in some 
persons had an offensive smell resembling that of the washings of a 
gun. This odour was emitted by those who, though not ill of the 
fever, were exposed to the prevailing cause. It was perceived even 
in those cases in which the disease went off on the first day of the 
attack. 3 In his history of the epidemic of 1794, the same eminent 
physician says: "I recollect having more than once perceived a 
smell which had been familiar to me during the prevalence of the 
yellow fever in 1793. It resembled the smell of liver of sulphur. 
I suspected for awhile that it arose from the exhalations of the gut- 
ters of the city. But an accident taught me that it was produced 
by the perspiration of my body. Upon rubbing my hands, this 
odour was increased so as to become not only more sensible to 
myself, but in the most sensible degree to my pupil, Mr. Otto. 
From this fact, I was convinced that I was strongly impregnated 
with miasmata." 4 Dr. S. Jackson mentions that in one case a most 
intolerable fetor proceeded from the patient's body for twenty-four 
hours before his entire and complete dissolution. 5 Drysdale, 6 in 
Baltimore ; Hill, 7 in Wilmington, North Carolina ; Gros, 8 in New 
Orleans; Stone, 9 in Woodville and Natchez; Dr. A. Hosack, in New 
York ; 10 Dr. Manson, 11 in New Haven, have made similar observa- 
tions during the epidemics they describe. 

I Traite de la F. J. 26. * Op. cit. iii. 85. 
3 Ibid. iii. 63. 4 Ibid. iii. 217. 

5 Fever of 1820, p. 54. 6 Med. Mus. i. 137. 

7 Med. Recorder, v. 90. 8 Rep. on Fever of 1817, N. 0. 12. 

9 Y. F. of New York in 1795, p. 16. 10 Webster's Collection,. 182. 

II N. 0. J. ii. 180 ; ibid. v. 453. 



AUTUMNAL FEVERS. 373 

Speaking of the fever of Woodville (1844), Dr. Stone remarks : 
" Sometimes before, and always after an attack, and not dependent 
upon the perspiration, a peculiar odonr was perceptible, which it is 
not easy to describe ; but which to have observed once is to remem- 
ber always ; I think I could detect the disease by this alone. One 
of my children, aged eight years, gave off this odour twelve days 
before the development of fever." Besides this, the perspiration 
was of an offensive odour. Of the symptom under present consider- 
ation, as it presented itself four years after in Natchez, the same 
writer says : " An odour which I cannot describe, but which was 
the odour that had been indelibly impressed on me in 1844, was 
strongly perceptible in many of the simplest cases towards the latter 
part of the epidemic, but which I did not notice for a month after 
its commencement." On this, as on the former occasion, the "per- 
spiration was always offensive, often fetid." 

In the yellow fever epidemics of Leghorn, and of various parts 
of the South of Spain, the same symptom was frequently observed, 
and is specially noticed in the numerous accounts of them which 
we possess. In the first-named city, the fetor was compared to that 
of fetid bile. 1 Arejula, 2 at Malaga, in 1803, likened it to the smell 
of putrid fish. It is mentioned by the same writer, Berthe, 3 and 
others, as of common occurrence during the epidemics of Anda- 
lusia, from 1800, and 1810. Martel, 4 in describing the disease as 
it occurred among the French soldiers in 1811, at Eotana, Lev- 
rilla, and Alcantarilla, lays great stress on that symptom. Dr. 
R. Jackson 5 informs us that, at Cadiz and Xeres, in 1820, the 
fetor emitted by the body of the sick, in some forms of the dis- 
ease, was singular — sickly and faint, and not unlike the smell 
of a fish-market. The next year, at Barcelona, Pariset 6 and his 
colleagues noticed a cadaverous odour in some, though not gene- 
rally. Audouard 7 mentions it as of frequent occurrence ; so does 
Lafuente, 8 and other Spanish writers. Bochoux 9 states that some 
of the sick emit a very offensive odour, analogous to that of gan- 
grene ; and adds that it is a usual attendant on the cutaneous exhala- 

1 Edinb. Journ. ii. 84. 2 Ibid. i. 448. 

3 Op. cit. 55, 56. 4 Quoted by Bally, 250. 

5 Epid. Y. F. of the South Coast of Spain, 105. 6 Op. cit. 435. 

7 Op. cit. 211, 393. 

8 Observaciones sobre la Fiebre Aniarilla, &o. Feriodico de la Soc. Med. Cir. i. 165. 
(See Rochoux, 472.) 

9 Rochoux, op. cit. 461, 472, 473. 



374 PNEUMONIA AND 

tion, whether the latter assumes the character of sweat or of insensi- 
ble perspiration. "It is not," he adds, "so strong as to be perceived 
from the street, as some physicians have asserted ; but we never fail to 
be struck with it when we uncover a patient and approach very near 
him. It is of an insipid nature {fade), somewhat nauseous, and 
adheres strongly to clothes." The same writer remarks, in ad- 
dition, that, on this point, the yellow fever approximates closely to 
hospital typhus, and the plague, both of which are characterized by 
a peculiar odour. 

Nor is this all ; Desportes, ' more than a century ago, noticed the 
same phenomenon in the fever of St. Domingo, where it was sub- 
sequently observed by Bally 2 and Gilbert, 3 the former designating 
it as fetid, the latter as cadaverous. Dr. E. Jackson 4 found in the 
West Indies, as he did in the fever of Europe, cases in which the 
perspiration had a peculiar smell, resembling that of a fish-market. 
In the fever of Dominica, as we learn from Dr. Imray, 5 the odour 
of the cutaneous exhalation was often extremely disagreeable as 
well to the patient himself as his attendants. Additional testimony 
on this subject might be gathered from the writings of Gillespie 
(34), Savaresi (273, 4), Madrid (25), Yatable (346), Frost {Med. Re- 
pos. xiii. 33), Comrie {Ed. J. xiii. 177), Ealph {Ed. Med.-Chir. Tr. ii. 
75), Arnold (10). 

The condition of the urine different in the two diseases. — It may not 
be improper to call attention, in this place, to the condition of 
the urine in the two diseases. As is known, this fluid in its normal 
state, contains, on an average, 11.88 of urea, 0.395 of uric acid, 
6.80 of inorganic salts, and 8.60 of organic matter. Of the salts, 
the chloride of sodium may be estimated at from z i%%% parts to 
f " D 4 5 in 1,000. Now when, with this before us, we inquire how 
matters stand in respect to malarial fevers and pneumonia, we find 
that these diseases differ in no inconsiderable degree from each other 
and from the state of health, so far as the proportionate quantity 
of those ingredients is concerned. In the former the urea is in 
less quantity than in health, presenting a proportion of only 9.01. 
At the same time, the quantity of uric acid attains an amount of 
9.80, or eight times larger than in health. As regards the inorganic 

1 Maladies de St. Domingues, i. 221. 2 Typhus d'Amerique, 247, 248. 

3 Hist. Mod. de l'Arraee Francaise a St. Domingue, 66. 

4 Sketch, i. 64. 5 Edinb. Med. and Surg. Journ. liii. 80. 



AUTUMNAL FEVEES. 375 

salts, we find them to rise as high as about 16.72, or much more 
than twice as high as in healthy urine, while the organic matter 
varies but slightly, if at all, from the normal state. As a matter 
of course, amid this increase in the salts, the chloride of sodium 
can suffer no diminution, and in all probability has increased in 
the same ratio as the other salts. 1 During the stage of apyrexia 
in intermittent fever, the urine is often found, so far as the above 
ingredients are concerned, in its natural state : a condition propor- 
tioned in great measure to the extended duration of that stage and 
the shortness of the febrile paroxysm. In some cases the fluid is 
healthy throughout. But in most instances the changes under con- 
sideration exist as well in the intermissions as during the parox- 
ysms, and are greater in proportion to the length of the disease. 
In no instance can we discover that the proportion of uric acid 
remains at the normal point, and that the quantity of the fixed salts 
falls considerably below. 

In reference to the phlegmasia?, and pneumonia in particular, the 
proportions are nearly reversed ; for Simon and other high che- 
mical authorities have shown that the urine therein exhibits a 
marked diminution of the inorganic salts, and a greater relative 
amount of organic constituents ; the proportion of the ingredients 
mentioned being urea, 7.3 ; uric acid, 0.4 ; fixed salts, 2.7 ; and or- 
ganic matter, 8.8. 2 In an examination by Becquerel (op. cit. 329), 
the following proportions, which differ but little from the preceding, 
were obtained : urea, 7.761 ; uric acid, 0.464 ; inorganic salts, 2.871 ; 
organic matter, 9.332. Of the salts, the chloride of sodium was 
early found to suffer a greater diminution than the others in all the 
phlegmasia?. Subsequent observations, made some three years ago 
by Dr. Redtenbacher, leave no doubt that, in pneumonia, the result 
in question is still more marked and constant than in inflammation 
of other organs ; for while in these the chloride is usually only greatly 
diminished, and sometimes, indeed, preserves its normal proportions, 
in pneumonia the quantity of the salt never fails to diminish gra- 
dually until the period of hepatization has occurred, when no traces 
of it can be detected in the urine, and only makes its appearance 
again as the resolution of the inflammation proceeds. It may be 
remarked that this effect cannot be due solely to the altered diet 

1 Becquerel, SemeTotique des Urines, 286-291 ; Heretier, Chimie Med. 528 ; Simon, 
op. cit. ii. 255-257. 

2 Simon, op. cit. ii. 216. 



376 PNEUMONIA AND 

taken by patients labouring under the disease, for other inflamma- 
tions require the same diet, and we have just seen that in them the 
phenomenon often fails to present itself. 1 

By Mr. Beale, of London, the subject has been recently taken up 
and apparently examined with considerable care; and from his 
researches in the matter, he arrives at the following conclusions : — 

1. That in pneumonia, there is a total absence of chloride of 
sodium from the urine, at or about the period of hepatization of 
the lung. 

2. That soon after the resolution of the inflammation, the chloride 
becomes restored to the urine, and often in considerable quantity. 

3. That at this period the serum of the blood is found to contain 
a greater amount of chloride than in health. 

4. That the presence of chloride of sodium in the urine may be 
taken as evidence of the existence of a greater quantity of the salt 
in the blood, than is required for the wants of the system gene- 
rally, or at least of an amount sufficient for that purpose ; and that 
the absence of the salt from the urine indicates that the circulating 
fluid contains less than the normal quantity. 

5. That the sputa in pneumonia contain a greater quantity of 
fixed chloride than healthy pulmonary mucus, if there be not much 
less than a normal amount in the blood, although there be a com- 
plete absence of the salt from the urine. In all cases, however, 
there is found in the sputa a quantity many times greater than 
exists in an equal amount of blood at the same period of the dis- 
ease. The absolute amount present is subject to variation at dif- 
ferent periods of the disease, and in different cases. 

6. That there is reason to believe that the absence of the chloride 
of sodium from the urine during the stage of hepatization, depends 
upon a determination of this salt to the inflamed lung, and that, 
when resolution occurs, this force of attraction ceases, and what- 
ever salt has been retained in the lung is reabsorbed, and appears 
in the urine in the usual way. 2 

Here, then, we perceive a strong contrast existing between 
pneumonia and malarial fevers — increase of urea in the one, and 
diminution of the same in the other disease ; diminution of uric 
acid in the former, and great increase in the latter ; diminution of 
the salts in the one, great increase of them in .the other; consider- 
able diminution, and finally total absence of the chloride of sodium 

1 Edinb. J. lxxx. 246. 2 Med.-Chir. Trans, xxxv. 355, &c. 



AUTUMNAL FEVEKS. 377 

in the one, increased or normal quantity of the same in the other 
disease; finally, vast increase of organic matter in the former, 
ordinary quantity of it in the latter. To this, let it be added that 
when in malarial fevers results of an opposite nature are obtained? 
they will be found due to an inflammatory complication. 

But I have sufficiently enlarged upon these topics. Nor shall I do 
more than refer to the peculiar acid alliaceous odour of the breath, 
which has been regarded, justly no doubt, as among the character- 
istics of yellow fever; 1 the pearly appearance of the gums in the 
same disease, to which attention was first called by Dr. Yaletti, of 
New Orleans ; to the peculiar indentation at the roots of the nails, 
" indicating the point at which their growth was suspended by the 
disease;" observed, it is said, in 184.-7, by Dr. Walkly, of Mobile, 
in all the forty-one cases he examined ; 2 or to the bluish discolora- 
tion of the gums said to be peculiar to all malarial diseases. These 
subjects have not yet been examined to a sufficient extent to be 
used in this place for purposes of comparison. 

Anatomical characters different in the two diseases. — Nor is the dis- 
crepancy less marked in regard to the anatomical characters of the 
two diseases. In the one, there is often no traces of inflammation, 
properly so called. When these do present themselves, they are 
seated in the gastro-intestinal surface ; sometimes, though not 
always, in the cerebral organs and membranes, and occasionally in 
the liver. As frequently, these organs are only congested. Usu- 
ally, the liver is neither inflamed nor greatly congested, being in 
some forms of fever (the bilious remittent) of a bronze hue, depend- 
ing on the deposit of a dark meloenic pigment, not unlike the dark 
solid substance of black vomit. It does not contain a larger quan- 
tity than natural of fatty matter, but is filled with bile. 3 In another 
form of malarial fever — the yellow — the organ is of a pale yellow 
colour, and dry anemic texture. It bears the marks of having se- 
creted little or no bile during the course of the attack, 4 and has been 
shown by Dr. A. Clark, of New York, whose discovery was fully 

1 Kelly, Am. J. xiv. (N. S.) 374. 2 N- . J. v. 481. 

3 Brit, and For. Med.-Ch. Rev. Jan. 1849, pp. 95, 96. Stewardson, Am. J. (N. 
S.), i. 313; Swett, ib. iii. 33, 35; Anderson and Frick, ib. xi. 332; Anderson (of 
Alabama), Prize Essay, Proceedings of Alabama Medical Association, 1852, p. 117. 

4 See Louis on Yellow Fever, and many other works on the same disease. 



378 PNEUMONIA AND 

confirmed daring the last autumn in Philadelphia, to contain, and 
to owe its peculiar hue, to the deposit in the hepatic cells of a large 
quantity of oily or fatty matter, which, in some cases, imparts to 
the organ much of the characteristic appearances of a common 
fatty liver. The spleen is usually found congested, softened, or 
enlarged, or even hypertrophied. This condition of the organ 
appertains more specially to the intermittent and remittent forms 
of malarial fevers, and has been noted universally in this country, 
in France, England, Holland, Algeria, India, and, indeed, in every 
country where these diseases prevail, and where dissections have 
been performed. It is noted also in typhoid, and in the relapsing 
fever of the British islands — so frequently, indeed, as to be viewed 
in the light of a characteristic phenomenon. 1 Finally, the blood 
in general is found altered in colour, often more or less fluid, and 
exhibiting, in malignant cases, signs of decomposition. But amid 
all these changes, the lungs remain unimplicated ; or, if otherwise, 
the occurrence is rare, and differs in nothing from what is seen in 
other acute diseases not especially seated in those organs. 

Here, then, we perceive that neither this affection, nor any local 
inflammation, nor a buffy or cupped blood form part and parcel of 
autumnal fevers during life, or leave traces after death. In the 
other disease, on the contrary — pneumonia — the lungs never fail to 
present marks of inflammation, varying in character according to 
the stage at which the disease had arrived; and while such changes 
are necessarily and invariably detected in those organs, the stomach, 
bowels, liver, and spleen are very usually found in their normal 
state. In fact, no sign observed during life, no anatomical character 
discovered after death, can be adduced in evidence of the pathologi- 
cal identity of those diseases, or induce us, for a moment, to think 
they arise from the same cause. In the one case, the latter consists 

1 Clegliorn, 84 (5th ed.); Monfalcon, 298,532; Addison, Lond. Med. Gaz. xxiii 
796 ; Forbes's Rev. xviii. 189 ; Tweedy, 33, Am. ed. ; Copland, ii. 1089 ; Henderson 
Edinb. J. lix. ; Dickson, Charleston J. i. 20; Am. J. July, 1852 ; Drake, i. 830, 842 
Swett, Am. J. (N. S.) iii. 33, 35; Stewardson, Am. J. (N. S.) i. 314; Bartlett, 332 
Anderson and Frick, Am. J. (N. S.) xi. 332; Haspel, Mai. de l'Algerie, ii. 201, 317 
J. Davy, ii. 236 ; Williams, ii. 470 ; R. Jackson, i. 80 ; Boudin, Geographia Med. 46 : 
Cycl. of Pract. Med. ii. 223 ; Twining, Fevers of Bengal ; Boyle, Dis. of West C. of 
Africa, 89, 141, 146 ; Durand, Mem. &c, sur les rates engorgees pendant les f. Interm. 
6; Bryson, 73; Evans, 221 ; Marshall, Top. and Dis. of Ceylon, 142; Watson, 455; 
Anderson, loc. cit. 117; Nepple, F. I. 61, 270; Audouard, Bulletin, xii. 151; C. 
Broussais, ib. 293; Corney, ib. 624; Maillot, 285; Bonnet, 214; Bailly, 162, &c. 



AUTUMNAL FEVERS. 379 

chiefly in some irregular mode of application of common atmospheric 
influences, which operate by occasioning, after a comparatively 
short, or even without any visible sedation, an inflammatory reac- 
tion in the organ affected, as also secondarily in the system at large. 
In the other case, the cause consists evidently of a peculiar poisonous 
matter floating in the atmosphere; the primary and prominent 
effects of which are subduction of the vital or nervous power, dimi- 
nution of vascular action, prostration, to a greater or less extent, of 
all the energies of life, and, as a consequence, of the vital affinity 
and cohesion of the soft solids and contamination of the circulatory 
and secretory fluids. These are doubtless attended, in the early stage 
of the milder cases and less violent forms, with symptoms of reac- 
tion, as well as with a functional derangement of important organs; 
but often this reaction is broken or imperfect ; and frequently the dis- 
ease is characterized, throughout its whole progress by symptoms of 
prostration. In a word, we perceive effects which bear, in the more 
severe and malignant forms of the disease especially, a close analogy 
to those occasioned by other and more tangible toxical agents. Like 
some of these, as oxalic acid or nicotine — the malarial and several 
other zymotic poisons, sometimes suddenly prostrate the system to 
the verge of the grave, or even destroy life in a few hours and during 
the first access, or, as Dr. Simon says, in the tremendous shock and 
depression thereby occasioned in the system. So rapidly destruc- 
tive, indeed, is the effect, that were it not for concomitant circum- 
stances it would often be difficult to form an idea of the real nature 
of the case. The narcotico-irritating quality of the poison is fully 
indicated by the phenomena of the opening stage of fever, for this 
is marked by a reduction of vital energy, obtuseness of sensibility, 
suspended or perverted secretion, and diminished calorification. As 
Dr. Drake remarks : " We may assure ourselves that its first effects 
will not be increase, but depression of excitement, by referring to 
the constitutional influence of foreign matters, liquid or gaseous, 
when introduced into one of the serous membranes (as the peri- 
toneum, for example) which are always those of depression as well 
as irritation." 1 

It may not be amiss to remark, while on this subject, that parox- 
ysms of febrile excitement, assuming a periodic type, and which, 
though not identical with, bear some analogy to, various forms of 

1 Op. cit. 733. 



380 PNEUMONIA AND 

malarial fevers, are not infrequently produced by agencies of a 
debilitating character, even though the localities where they occur 
are free from periodic fever; and we know that in paludal or fever 
districts, attacks of the disease are sure to be brought on by the 
application of such agencies, and that experience has taught the 
necessity of avoiding, in such districts, a mode of living calculated 
to place the system below par. Of the first of these causes, one 
example will suffice. M. Kenouard communicated to the Academy 
of Medicine of Paris, in 1847, an account of several cases in which 
periodic paroxysms of fever were produced in a non-malarial locality 
by copious losses of blood. In one of these instances the disease 
produced assumed a regular tertian type ; in two others the fever 
was remittent. All were cured by a tonic and quinine treatment. 1 

The two diseases differ widely as regards the duration of the process 
of incubation. — Other reasons may be adduced in support of the 
opinion here advocated. In one of these diseases — periodic or 
autumnal fevers — the period of incubation or latency, L e. the period 
daring which the system tolerates the poison, and the latter remains 
apparently innocuous until reaction is brought about by some in- 
trinsic circumstance of the depressing kind or otherwise — though 
considered as very short by Macculloch, 2 Nepple, 3 and a few others, 
is often found to be very greatly prolonged ; while in every case of 
pneumonia the morbid effect soon follows the application of the 
cause. The yellow fever poison, though occasionally rapid in its 
effects, and attacking but a few hours or days after exposure, re- 
mains at times dormant in the system as long as fifteen, thirty, or 
fifty days. In one case mentioned by Blair (69, 70), the period 
seemed extended to four months. In a private communication to 
the author, Dr. Merrill states that during the epidemics of Natchez, 
which he witnessed, the period of incubation occasionally extended 
to fifteen days. M. Bertulus, who saw the disease in the West 
Indies, limits the period to from three to eight days, and affirms 
that it never extends beyond three weeks. 4 Dr. Stevens, also, who is 
well acquainted with the true yellow fever, which, in accordance with 
his views, respecting its origin and nature, he denominates African 
typhus, states that it never produces its effects previous to the fourth 

1 Bulletin, xii.' 640. 2 An Essay on Marsh Few i. 20. 

3 Traite" de la F. Int. 146. 

4 Mem. sur l'lntoxication Miasmatique, 39 



AUTUMNAL FEVERS. 381 

day, and that he has known some well-marked cases in which, the 
poison being applied in a less concentrated form, the individuals 
were not attacked until twelve days had elapsed after exposure. 1 
From all the facts I have myself been enabled to collect, I am of 
opinion that, though sometimes very short, and at others very long, 
the period of incubation in yellow fever usually varies from five to 
ten days. 

In other forms of malarial fevers, the period of latency is seldom 
shorter than three or four days. In general it extends beyond this, 
and has not unfrequently been known to reach a limit far exceeding 
that noticed in the yellow fever. Our lake fever, according to Dr. Ste- 
vens, has an incubative period of about a week ; but, when the poison 
is concentrated, an attack often comes on as early as the third day — 
never sooner. 2 In the epidemic of Naples, in 1764, the disease some- 
times, though rarely, broke out immediately after exposure. In the 
greater number of instances, the poison remained latent to the end 
of the first week. 3 Dr. John Hunter states that, on the Watering ser- 
vice in the West Indies, some fell sick on the first and second day ; 
others embarked and were seized on the tenth or fourteenth day, or 
even three weeks after exposure. 4 He informs us that the Suffolk 
militia were called, in 1793, from their healthy country to Hilson 
Barracks, the low, marshy, unhealthy situation of which is pro- 
verbial. Twenty-two died before they left at the end of June. In 
July the regiment, with eleven other battalions, encamped at Water- 
town, near Tunbridge Wells. One hundred sickened soon, out of 
five hundred, with fever. Some were taken ill in October, or four 
months after leaving the Hilson Barracks. The 18th regiment, in 
1783, after being at the same barracks from June 22 to October 9, 
were sent to Gibraltar. There were then sixteen of the men labour- 
ing under ague. While at Gibraltar, though the regiment was only 
four hundred strong, the disease spread so rapidly among them, 
that by May the cases amounted to two hundred and eighty (in- 
cluding women and children), of whom a part were then recently 
attacked for the first time. Whilst such was the course of events 
in this ill-fated regiment, the disease did not exist in any other part 
of the garrison.' Dr. Hunter adds that, "ships returning from a 
warm climate, particularly if they have been in harbour during the 

1 Stevens on the Blood, 235. * Op. cit. 243. 

3 Sarcone, Maladie de Naples, ii. 73, 74. 4 Op. cit. 153. 

5 Ibid. 327-334. 



382 PNEUMONIA AND 

unhealthy season, have many of their men taken ill of the remittent 
fever, even two or three months after being at sea. 1 

Some of the British soldiers who inhaled the pestiferous atmo- 
sphere of the Walcheren Marshes, were attacked for the first time 
in healthy situations in England — Colchester, Woodbridge, &c. — 
as late as nine months after they were brought back. 2 The follow- 
ing facts, communicated to Dr. Bancroft by Mr. Nixon, surgeon to 
a battalion of the 1st Eegiment of Foot Guards, will be read with 
interest. The battalion landed on South Beveland on the 2d of 
August, 872 strong. On the 19th, the endemic appeared among 
the men, and between that day and the 4th of September, when the 
men embarked for England, i. e. sixteen days, 359 of them were 
attacked. The battalion was landed at Chatham about the 7th or 8th 
of September. Many of the men continued to be attacked with 
endemic fever, so that by the 8th of March, 1810, only 117 of the 
original strength had escaped the disease in question. Some of the 
117 men were attacked with intermittent fever as late as the middle 
of the month of June. 3 Dr. Ferrus, a distinguished physician of 
Paris, relates a striking instance of the kind. Three hundred men, 
of the old Imperial Guard, to which he was surgeon at the time, 
were exposed to the cause of autumnal fevers in Breslau. Many 
of them took the disease ten days after leaving the place ; other 
cases followed, and the fever became general. Dr. Ferrus himself 
was attacked six months after, while stationed on the Niemen, 
where no disease of the kind prevailed, and at a period when the 
country all around was perfectly healthy. 4 Of forty cases of inter- 
mittent fever which occurred on board the H. C. ship Barrosa, in 
1832, 1833, three took place seventy to eighty days after leaving 
England; thirty-one while lying at Whampoa; and seven from two 
to three months after leaving Canton, and ninety-three days after the 
disease had ceased in the ship. 5 Labourers, especially the Irish 
will go down, for harvest work, into Lincolnshire, and bring back 
the seeds of ague within them, and yet may not be attacked for 
weeks or months. 6 M. Boudin calls attention to a fact which he him- 

1 Op. tit. 835. 

2 Bancroft on Yellow Fever, 241, 304; Blane Diss. i. 244; Williams, Morbid Poi- 
sons, ii. 4G5. 

3 Bancroft, 307, 308, note. 

4 Diction, de Med. xii. 6 ; ibid. 2d ed. xviii. 69. 

5 Peterson, Med. Gaz. xv. 269. 6 Med. Gaz. xxviii. 365. 



AUTUMNAL FEVERS. 383 

self noticed ; that regiments that had returned to Marseilles, where 
periodic fevers are but little known, from the malarial districts of 
Algeria and Corsica, as well as those that had formed part of the 
expeditionary army of the Morea, continued during several years 
(des annees entires) to suffer from diseases bearing unequivocal 
marks of the fevers of the localities they had left. 1 Towards the 
close of the year 1843, two regiments of infantry arrived at Cour- 
bevoie ; the one (23d Light Infantry) coming from a northern gar- 
rison, the other from the citadel of Strasburg, where malarial fevers 
prevail extensively. The two regiments occupied the same bar- 
racks, performed the same duties, partook of the same fare, and 
were in every other respect on the same footing. Yet, while the 
first of these regiments suffered from typhoid fever and pneumonic 
inflammations, the other furnished, for more than a year, a large 
number of intermittent fever cases. The disease spread to several 
hundred of the men, and spared few — not even those who had not 
had it during their stay in the malarious locality whence they 
came. 2 A similar occurrence was observed in another regiment 
(the 75th) transferred from Strasburg to Versailles, in the autumn 
of 1843. In December of the year following, the fever was still 
prevailing, but only among the men who had arrived from Stras- 
burg ; the new recruits remaining free from the disease. 3 In an- 
other essay, M. Bouclin remarks : " So far as regards myself, after 
a survey of the numerous observations we have collected in France, 
at periods and in localities exempt from periodic fevers among 
men arriving from the paludal districts of Corsica, Morea, and 
Africa, we have no hesitation in declaring that the period of 
latency of the malarial intoxication may extend to eighteen 
months." 4 

One of our countrymen, Dr. L. H. Anderson, of Alabama, in his 
Prize Essay, already referred to, states that he was himself attacked 
in the city of Paris, six months after leaving a mountainous dis- 
trict, with an intermittent of a very different character from the 
fever usually observed in that city. The remote cause, as he 
remarks, had no doubt been harboured in the system all the time, 
his general health appearing, notwithstanding, for three months 
before the attack, better than it had been for years. The exciting 

1 Annates tVHygiene, xxxiii. 63. z Loc. cit. 64. 

3 Ibid. 65. 4 Boudin, Geographie Med. 64. 



384 PNEUMONIA AND 

cause, Dr. Anderson thinks, was doubtless the bad air of the hos- 
pitals, dissecting-rooms, &C 1 » 

Dr. Lee relates the case of an officer of our navy, who was ex- 
posed several years before to the highly concentrated miasm which 
produced the fatal endemic among the residents of Thompson's 
Island, on the Florida coast. Although he escaped the bilious 
remittent, which proved so fatal to many others, he yet had occa- 
sional attacks of genuine intermittent, for several years afterward, 
on exposure to cold, moisture, or great fatigue, although residing 
in a part of New England where intermittents were never known 
to prevail. 2 

In all fenny countries, individuals exposed to the miasmata of 
autumn are often affected for the first time the following winter or 
spring; while exposure, at the latter seasons, in the same locality, 
is in no way attended with danger to those who have not imbibed 
the malaria. So frequently is this result obtained, that it is very 
generally admitted by the most accurate and cautious observers, 
that vernal or winter periodic fevers are the offspring of autumnal 
exposures. For the occurrence of such cases in this country, we 
may, as Dr. Drake has done, refer to the experience of every phy- 
sician who resides in regions infested with autumnal fever. 3 

This power of prolonged latency is an attribute of diseases arising 
from the agency of morbid and specific, and of many common poi- 
sons — whether they are endowed or not with contagious pro- 
perties — and its manifestation by autumnal fevers, establishes the 
fact of a close connection between malaria and the other class of 
morbid agencies alluded to, and indicates the propriety of referring 
that fever to a cause of kindred nature. According to Hildenbrand, 
the incubative period in typhus varies from three to seven days 
(p. 30). Haygarth 4 says, that of 72 persons exposed to the poison, 
5 were attacked within ten days ; 13 between the tenth and seven- 
teenth day ; 41 between the seventeenth and thirty-second ; and 1 
on the seventy-second. Of typhoid fever, we find that the period 
of latency, though usually short, is sometimes as long as it is in 
typhus, if not longer. Boudin states that at Algiers and Bone, 

1 Proceedings of the Ala. Med. Assoc, for 1852, p. 115. 

2 Copland's Diet. ii. 1090, note. 

3 Topog. &c. of the Miss. Valley, i. 813; Cooke, Med. Recorder, vii. 459; Edinb. 
J. lxxi. 355; Stevens on the Blood, 241. 

4 Letter to Dr. Percival, 68. 



AUTUMNAL FEVERS. 385 

where this form of fever does not prevail or originate, troops 
arriving from Marseilles suffered from it for a few months, while 
others that arrived from elsewhere, or had been in the country 
some time, were exempt. 1 Dr. Williams states that the period may 
extend to five or six months. 2 

None of our readers need be told that some mineral poisons — as 
arsenic, mercury, and lead, for example — occasionally do not manifest 
their baneful or remedial effects until a long while after being ab- 
sorbed; and may give, during a still longer period, proofs of their 
existence in the system, without, however, producing actual disease, 
or even indisposition. Orfila found, on the 3d and 7th of February, 
arsenic in the blood drawn from the arm of an individual who had 
swallowed a quantity of the metal on January 28th. In another 
case, he found the same substance in the blood twenty-two days 
after it had been taken. 3 The pestilential pustule (bouton cPAlep) 
does not break out, in some cases, until months after exposure. 
Boudin mentions a case in which it made its appearance in France 
ten months after the return of the individual from the East. 4 Au- 
bert Roche states that, during a period of one hundred and twenty- 
two years (1717-1841), the incubation in plague was not found to 
be prolonged beyond eight days. 5 

The researches of the commission appointed by the Academy of 
Medicine of Paris, to investigate the subject of quarantine, lead to 
the conclusion that the incubation of the plague varies according 
to the period of the epidemic and other less influential circum- 
stances. In the early period of an epidemic, the incubation is short. 
In the second period, and subsequently, its duration varies from 
three to five days. The larger number of the authorities consulted 
were of opinion that the incubative process did not exceed eight 
days ; some thought it might run to the tenth day, or even beyond. 
Such cases, however, appear to have been rare. Nevertheless, 6 
Pariset mentions a case in which the period extended to the thir- 
tieth day. 7 

The usual length of the period of latency in hydrophobia is esti- 
mated at between thirty and forty days. Mr. Demeunynk, in a 

1 An. d'llyg. xxxiii. 63; Geog. Med. 50. 2 Morbid Poisons, i. 40. 

3 Bulletin de l'Acad. de Med. iii. 598, 676. 4 Ge"og. Med. 65. 

5 De la Peste ou Typhus D'Orient, 85. 

6 Rapport a l'Academie, &c. 196, 197; Clot-Bey, 19. 

7 Revue Medicale, Sept. 1844. 

25 



386 PNEUMONIA AND 

memoir presented to the Academy of Medicine, in May, 1839, 
relates three cases. In one, the period of incubation extended to 
thirty -two days ; in the second, it reached to fifty -four days ; and in 
the third, the disease did not break out before three months. 1 
Fothergill 2 mentions the case of a Mr. Bellamy, who was bitten by 
a rabid cat, and was attacked with that disease four months after. 
Similar cases are mentioned by Mosely and Dr. Matthei of Geneva ; 
Vaughan extends the period to seven months; Fracastorius to 
eight; 3 Mead to eleven; 4 Bauhin to twenty-two; Dr. John Hunter, 5 
K. Hamilton, and Nurse, to from seventeen to nineteen ; Grant to 
twenty; 6 while Lentilius speaks of three years; M. Bouillod of 
seven years ; 7 Dr. Bardsley of twelve years ; and Morgagni of twenty, 
and even forty. Leaving out the latter very extraordinary cases, 
for the correctness of which I am not prepared to vouch, and which 
may have been, and probably were, the effect of the imagination, or 
symptomatic of some other complaint, there is enough left to show 
that the period of latency in hydrophobia is occasionally very long. 
The length of the period in cowpox varies from three days to three 
weeks. In a case observed by M. De Lens, the disease did not 
show itself before a full month. 8 In another, mentioned by Dr. 
Stevens, the pustule did not make its appearance until six weeks 
after vaccination. 9 

The usual period in chancre is from four to eight days, unless 
the surface is abraded. Hunter has known the disease to be re- 
tarded as late as seven weeks. Secondary syphilis breaks out 
ordinarily between six weeks and six months after the cure of the 
primary symptoms ; sometimes, however, not before several years. 
In one case, mentioned by Williams, the disease did not show itself 
in fifteen years. The average incubative period in smallpox is 
estimated at fourteen days, from exposure to the contagion, to the 
appearance of the eruption — the extremes being one and three 
weeks — five to twenty-three days, according to Williams. In the 
greater number of cases, no uneasiness is experienced before the 
eleventh or twelfth day after exposure. The period in scarlatina 

1 lieport by M. Dubois, Bulletin de 1' Acad. iii. 929. 2 Works, ii. 222. 

3 De Contag. 123. 4 The Med. Works, 57. 

5 Cyclop, ii. 492. 

6 Med. and Phy. Tr. of Calcutta, ii. 51. 

7 Anglada, Traite de la Contagion, i. 269. 

8 Bousquet, Traite de la Vaccine, 525. 9 On the Blood, 237. 



AUTUMNAL FEVEKS. 387 

is from a few hours to ten days. In measles, from ten to sixteen 
days. 1 

Process of latency governed by definite laws. — The results of observa- 
tions made during a period of a third of a century, have inclined 
me to the opinion, which others had adopted long before, that the 
process of latency in autumnal fevers is ordinarily governed, as 
regards duration, by certain definite laws, analogous to those which 
preside over the progress, fluctuations, and return of the same and 
some other diseases. The late Dr. E. Jackson was of opinion that 
the aptitude to receive the morbific impression of the cause of fever, 
takes place more at particular periods than others; that it manifests 
itself more frequently about the fourteenth day after communication 
with an infected source, and that it is observed chiefly at septenary 
periods, the seventh, fourteenth, twenty-first, &c. from the time of 
exposure. This opinion was based upon the results of his own ob- 
servations, " made upon numerous bodies of men ; upon healthy men 
placed as attendants in infected hospitals, and upon healthy soldiers 
sent to concentrated sources of endemic fevers." Among such, fever 
scarcely ever appeared before the seventh day, commonly not be- 
fore the fourteenth, and in numerous instances not till the expira- 
tion of six weeks, or even two. months ; though the cause of disease 
during the time was ordinarily in great activity. 2 Nor has it failed 
to be noticed that intermittent fevers exhibit, during their course, 
a tendency to a septenary revolution ; that at those periods, either 
after the seventh, fourteenth, or twenty-first paroxysm, the disease 
has a disposition to terminate spontaneously. This was frequently 
verified in Florida, under Dr. Forry's observations, 3 and has been 
noticed sufficiently often elsewhere to justify its being viewed in 
the light of a well-established fact. In remittent fever, the same 
tendency is noticed, the disease having a particular disposition to a 
favourable critical change on the seventh, fourteenth, twenty-first, 
and twenty-eighth day. 4 Nay, more, there are not wanting facts to 
show that the tendency to relapse in autumnal fevers is governed 
by analogous laws. We know that in the form of fever, which, 
from its constant return at stated times, after apparent convales- 
cence, has received the name of the relapsing fever, the symptoms,. 

1 Williams on Morbid Poisons, i. 40, 120, 172, 214. 

2 Outlines, 247, 248. 3 Climate of the United States, 283. 
4 Jackson, Sketch, i. 197 ; Copland, ii. 1101. 



388 PNEUMONIA AND 

after the critical sweat of the fifth or seventh day, generally return 
on the fourteenth; and those relapses recur not only once, but 
several times. Other fevers, in like manner, show a disposition to 
recur at stated periods. In the government of Ufa (Eussia), 
autumnal fever, which in that section of country is very common, 
attacks the patient every seventh day only, and is so severe that it 
generally proves fatal. 1 Similarly to what occurs in relation to the 
decline of the disease, or to its attack after exposure to the cause, 
the periods most remarkable, according to the ample experience of 
Dr. E. Jackson, for the recurrence of the symptoms are the sep- 
tenary; the seventh, fourteenth, twenty -first, and twenty-eighth, 
with, as that high authority adds, new and full moon. 2 Whether 
the doctrine will bear the test of observation, particularly in its 
application to the period of latency, time must determine. Suf- 
ficient is it for our present purpose to call attention to the fact, 
that, should the statement of Dr. Jackson and others, relative to the 
period of attack after exposure, be well founded, it furnishes an 
illustration of the connection between the period of latency and the 
septenary revolutions of the system, so far, at least, as the number 
of those revolutions have been counted. To this I must add, that 
individuals who relapse with fevers, do so, in all probability, in 
consequence of the cause not being completely eliminated from 
their system, a^.d remaining in a latent state during the period of 
exemption. If this be admitted, and we find that these relapses 
take place at regular septenary periods, we derive from that fact a 
proof that the process of latency is under the influence of the law 
of septenary revolution. 

Much may be said concerning the above law relative to the period 
of seven days in fevers ; for it is one which, as Dr. Laycock has 
forcibly shown, is of very general application in the explanation of 
vital phenomena in health and disease. Everything, indeed, leads 
to the conclusion that a period of seven days, and definite fractions 
or multiples of that period, are very prominent in the series of 
phenomena called critical days, and the operations of the system 
generally. It forms part of the great fact of vital periodicity, to 
which attention was called by some of the most ancient writers who 
have left records of their observations. The doctrine of septenaries 

1 Notices of Russia, United Service Journal, Jan. 1833, p. 49. 

2 Sketch, ii. 212; Outline, 304. 



AUTUMNAL FEVERS. 389 

is literally as old as the Lulls. Originating probably with the Chal- 
deans or Egyptians, it formed part of the system of Pythagoras ; 
and its application, to the phenomena of disease particularly, is dis- 
cussed by Hippocrates, Diodes, Galen, Celsus, and others. In his 
ingenious speculations on the periodicity of the phenomena of life, 
Dr. Laycock has shown that the critical days of health, and the 
critical da}-s of fevers produced by the entrance of a poison into 
the system — whether that poison consist in malaria, or in a conta- 
gious matter — are identical ; that the depression of the system will, 
in consequence, take place at those critical days, and that a fever 
depending on a poison is more likely to appear on those days than 
on any other. In confirmation of this, he states that the latent 
period in most diseases is regulated by weeks, as are also the latent 
period of animal poisons. He remarks that, in accordance with 
this law, the latent period of fever rarely extends beyond twenty- 
eight days. " If we take menstruation as a type of the critical days, 
and suppose that a movement takes place every seven days, gra- 
dually becoming more intense at each up to the fourth week, we 
have fever days, at least in every month in which the peculiar 
symptoms of the poison, whether malarious, exanthematous, or con- 
tagious, may exhibit themselves; probably the number may be 
greater ; but if one or two of these days be passed over without an 
outburst of febrile action, it is scarcely possible that the third or 
fourth will." 1 

In the fevers of hot climates, which are all or for the most part 
malarial, the doctrine of critical days, such as it has been transmit- 
ted down to us from the days of Hippocrates, has been amply veri- 
fied. On this subject, we have the testimony of high professional 
authorities. 2 In the fevers of Europe, it has been found equally 
applicable; 3 and in this country, when the efforts of nature are 
not too much interfered with by an heroic perturbative treatment, 
the Hippocratic doctrine often shines out in all its purity. To this 
fact, which some twenty or thirty years ago it would have been 
considered heresy to allude to approvingly, the eyes of our more 

1 London Lancet, Oct. 1842, p. 161. 

2 Poisonnier Fievre de St. Domingo, 119; Desportes, Mai. de St. Domingue, i. 198, 
232 ; Dazille, Maladies des Negres, 36, 65 ; Bajon, Mem. sur Cayenne, i. 2d Mem. ; 
Leblond, Fievre Jaune, 43 ; Levacher, Guide Med. 50. 

3 Hildenbrandt, Med. Pract. pt. i. chap. v. ; De Haen, Pract. Med. pt. i. cap. iv. ; 
Baglivi, Opera, 80. 



390 PNEUMONIA AND 

enlightened physicians are opening. Even in sections of country 
where formerly the idea of critical days met with most opposition, 
a very different sentiment is now found to prevail in the minds of 
correct, careful, and enlightened observers. Let one example suf- 
fice. Dr. Anderson of Alabama, in a prize essay, already cited, 
after remarking that a second exacerbation takes place the next 
day after an attack of fever, generally after meridian, adds : " This, 
in turn, gives way during the night, or towards morning, and an- 
other remission, more or less decided, is observed. If the fever 
take the double tertian type, the next exacerbation will come on 
during the morning, and will be followed by another the succeeding 
evening. The fever thus continues, sometimes rising during the 
same hour every day, and sometimes later on alternate days, until 
the sixth, when, if the observations of the writer of this essay are 
worth anything, the fever (if it terminate favourably) has a decided 
spontaneous tendency to decline, and leaves the patient free from 
disease on the seventh day." Again: " The fever (malarial) is gene- 
rally at its height on the fifth day; and, in bad cases, this is the 
day of danger. In malignant tertian intermittents, the fifth is the 
day for the third paroxysm, universally known to be the most 
hazardous; and, when death occurs in the disease, it commonly 
takes place either on that day or during the next." " Commencing 
practice," continues Dr. Anderson — whose fate, in that respect, has 
been similar to that of hundreds of physicians of this country — 
M with an utter disbelief in the doctrine of critical days, the contrary 
opinion has been forced upon me by actual observation. I am 
aware that the idea is discarded by a majority of physicians of the 
day; but I think that if any practitioner in the southwest will 
carefully note down the days in which malarious fever makes its 
appearance, and record accurately its subsequent course, he will 
find that the doctrine has a foundation in fact, and is worthy of 
some consideration. It is true, that the fever may often be made 
much lighter, or apparently arrested by the administration of qui- 
nia during the remissions ; but it will generally be observed that 
the patient does not frankly recover, and that it is not until the 
seventh day that he seems actually well, and clear of all symptoms 
of the disease." 1 

But it is not necessary to enlarge farther on these topics. Enough 

1 Proceedings of the Med. Assoc, of Alabama for 1852, p. 107. 



AUTUMNAL FEVERS. 391 

has been said to prove to the most fastidious inquirer that, in 
periodic fevers, the period of latency is occasionally remarkably 
long ; that in these diseases, as in others appertaining to the class 
of zymotics, the incubative process, the occurrence of relapses, the 
duration of the attack, and the period of critical changes are under 
the control of certain definite laws. May it not be asked whether 
anything of the kind has been observed in regard to pneumonia 
and kindred inflammations ? A prolonged incubation in such dis- 
eases may, for what I know, have been noticed elsewhere ; but so 
far as the experience of the physicians of this section of the country 
extends, it may be safely averred that nothing of the sort has 
occurred, and I tax my memory in vain for a reference, bearing on 
this point, to some one of the many publications, foreign and native, 
that have passed through my hands. Never and nowhere have I 
seen, or heard, or read of a case in which the attack has come on, 
whether abruptly or preceded by premonitory symptoms, more 
than a few days after exposure to the cause. An incubation of 
eighteen months or a year, of a month, or of a fortnight, has never 
been, and probably never will, nor can be seen or heard of in such 
complaints. Neither can we find that the process of incubation or 
latency is under the controlling influence of any fixed law, and has 
a fixed and regular duration. The same may be said of relapses 
which may occur at any period during convalescence, whether on 
an odd or even day. Such, at least, may be presumed to be the 
case, for so far nothing satisfactory has been adduced to prove that 
the phlegmasiae are, in regard to relapses, governed by the law of 
septenaries. How far the action of the same law extends relatively to 
the duration and periods of critical changes in those diseases, remains 
yet a mooted point. That the influence is exercised to a certain 
extent, may. possibly be one day conclusively shown; for in some 
diseases other than those produced by malarial or contagious poi- 
sons — hemorrhages and nervous complaints — the intervals are often 
regulated by weeks ; and in sundry acute and even chronic diseases, 
we not unfrequently observe — especially in the first, as Dr. Laycock 
well remarks — a movement of a tertian or quartan type, or in clini- 
cal phraseology, a good and a bad day. 

In pneumonia, as in other affections attended with febrile reac- 
tion, the same tendency to a movement of the kind is often mani- 
fested, and the disease is found in many cases to end on particular 
days. But, so far as observations go, the exhibition of a tertian or 



392 PNEUMONIA AND 

quartan movement, is not as generally noticed in such complaints 
as in the pyrexia, while the disease is far less under the control, 
in regard to the period of critical changes and to duration, of the 
law so often referred to. If exceptions are encountered ; if cases 
of this and other kindred diseases are found, in which the critical 
movements referred to are as marked and regular as they are in 
autumnal fevers generally, it is principally among those on which 
the malarial poison has produced its impress, or which are com- 
bined with a malarial complaint. For this poison, while engrafting 
the periodic type on the diseases with which it combines, imparts 
to them many of the other peculiarities which characterize its legi- 
timate offspring. True it is, that Dr. Traube has, in his experi- 
ments, found that in many cases of pneumonia the period of 
termination was marked by some critical discharge; and that in 
many the change began to take place — when the disease ended 
within the first fortnight — either on the third, the fifth, seventh, 
ninth, or eleventh day. Out of fifty-two cases of disease analyzed, 
the change suddenly took place in thirty. Out of twenty-seven of 
these, four ended on the third ; nine on the fifth ; eleven on the 
seventh ; two on the ninth ; and one on the eleventh day. In two 
of the remaining cases, the beginning of the disease could not be 
accurately fixed, and in one the change took place on the seven- 
teenth day. Dr. Traube's reviewer, Dr. Herman Weber, remarks : 
" Amongst sixty-two acute cases, into which we lately accurately 
inquired with this purpose, in eighteen only could we ascertain the 
commencement of the disease ; in five of these cases the notes on the 
temperature are not sufficient to be analyzed for the present sub- 
ject ; of the remaining twelve, the change took place rapidly in 
eight cases, and of these, on the fifth day, in two cases ; between 
the fifth and sixth day, in one case ; on the seventh day, in two 
cases ; between the seventh and eighth, in one case ; on the ninth 
day, in one case ; between the ninth and the tenth, in one case." 1 
But the number of cases in which the observation held good is, 
after all, but small ; and of those in which it was verified, we are 
not positively informed how many were of pneumonia, and whe- 
ther the disease was pure or complicated ; and as we find that 
many of the individuals experimented upon were affected with 
typhoid fever, and as this, like other zymotic diseases, may reason - 

1 See Brit, and For. Med.-Chir. Rev. xi. 44, 45. 



AUTUMNAL FEVERS. 



393 



ably be supposed to be governed by different laws from common 
inflammation, we can derive no accurate information relative to the 
subject before us, so far as it applies to pneumonia, from the state- 
ments, interesting as they doubtless are, of those writers. Besides, 
if, in some cases of this disease, the influence of the law is found to 
be felt ; in a greater number of others, not less accurately observed, 
it has failed to be so. 

Andral remarks that pneumonia is one of those diseases in which 
the question seems the most easy to decide ; because, on the one 
hand, the precise period of its onset is often very well marked ; 
while, on the other, the period of its termination is often just as 
easily ascertained. One hundred cases gave the following results 
in the hands of this accurate observer : — 



3 ended 


on the 


2 


(< 


u 


6 


u 


It 


23 


u 


u 


2 


it 


u 


4 


a 


u 


11 


u 


u 


13 


u 


u 


1 


u 


a 


2 


u 


it 


11 


it 


a 


2 


u 


a 


2 


u 


a 


9 


u 


a 


1 


it 


a 


1 


u 


it 



4th ( 


lay. 


5th 


a 


6th 


it 


7th 


tt 


8th 


u 


9th 


u 


10th 


a 


11th 


a 


12th 


u 


13th 


a 


14th 


« 


15th 


u 


16th 


a 


20th 


a' 


27th 


a 


42d 


a 



Of the remainder, the period of termination could not be ascer- 
tained precisely. 

3 lasted from . . . 5 to 7 days. 
12 " " . . . . 7 to 14 " 

7 " " .... 14 to 20 " 

4 " " . . . . 20 to 30 " 

From this it follows that the days on which the larger number 
terminated, were the seventh, eleventh, fourteenth, and twentieth. 1 



Clinique Medicale, i. 558, 559. 



394 PNEUMONIA AND 

To a certain extent the result is favourable to the Hippocratic doc- 
trine, though it must be borne in mind that the number of cases 
which ended on those days did not amount to more than one-half 
of the whole. On the other hand, the results obtained by Grisolle, 
are far from corroborating any conclusion favourable to the afore- 
said doctrine that might be drawn from the facts heretofore 
adduced. This author studied all the phenomena of the disease, 
from the beginning to the end, in one hundred and thirty cases. 
In thirty -four of these, or about one-third, the period of the resolu- 
tion coincided with some of the phenomena usually regarded as 
critical. In twenty -two, there was sweat, with or without deposit 
in the urine, either spontaneous or artificially obtained by nitric 
acid. In six, the disease ended by eruptions on the lips ; in four, 
by urine ; in two, by hemorrhage. To a certain extent the absence 
of critical movements in those cases may have been due to the kind 
of treatment pursued ; and to the same circumstance may be ascribed 
the fact that these movements are less trenchant, or easily made 
out at present, than they probably were in Greece at the time of 
Hippocrates, whose treatment, as Baglivi 1 remarked long ago, was 
purely expectant, and did not disturb or oppose the efforts of nature. 
But to this cause alone we shall not feel disposed to ascribe the 
whole of the difference, if we bear in mind that, though more active 
now than it was in ancient times, the treatment, in the hands of 
judicious and skilful physicians, has for its main object the aiding 
nature, and that, if those critical movements were in pneumonia, as 
in fevers, the governing power, they would be promoted instead of 
impeded by the means employed. To this, let it be added that, in 
regions of country similar to Greece in respect to climate, cases of 
pneumonia in which the phenomena in question are well marked, 
the effect has usually been found to be the result of a complication 
with a malarial disease. 

As to the period at which those critical phenomena manifested 
themselves, one of the cases observed by Grisolle ended on the 
fourth day ; seven on the fifth ; four on the sixth ; three on the 
seventh ; two on the eighth ; eleven on the ninth ; one on the tenth ; 
and three on the thirtieth. Few, as will be perceived, presented 
salutary discharges on what Hippocrates regarded as the essentially 
critical days, the seventh, fourteenth, and twentieth. So far from 

1 Opera Omnia, 80. 



AUTUMNAL FEVERS. 395 

it, the greater number of critical discharges (twenty) presented 
themselves on those days when the crises were considered by him 
as occurring less frequently, and as being less effectual. In eight, 
the change took place on empty days, i. e. those which were not con- 
sidered as periods of crisis ; and four presented critical movements 
on the sixth day, which, by the Hippocratic school, was viewed as 
the most pernicious, and hence was denominated, by Galen, the 
tyrant. From all this, Dr. Grisolle very justly infers that the doc- 
trine of critical days is very unsettled, " and that it cannot be re- 
garded as founded, so far as relates to pneumonia." 1 If, in addition 
to all this, we inquire as to the results observed in ten cases in 
which the disease was left to the powers of nature, we find that, in 
more than one-half of that number, the crisis took place on empty 
days ; convalescence commenced in six on those days, and in four 
only on genuine critical days ; a circumstance militating still more 
strongly against the doctrine in its application to the disease in 
question. 

In some forms of autumnal fever the susceptibility of the system ex- 
hausted by one attach — not so in pneumonia. — It is a fact very generally 
conceded, that one attack of some forms of malarial fever exhausts 
the susceptibility of the system to the subsequent action of the 
poison giving rise to them. This is more particularly the case with 
respect to the yellow fever, which, according to the highest profes- 
sional authorities in various parts of tropical climates, as well as in 
Europe and this country, seldom, if ever, attacks the same indi- 
vidual more than once. I am aware that exceptions on this point 
are to be met with ; that by some they are represented as being 
quite numerous, and that by a different set of authorities they are 
maintained to be so frequently encountered as to invalidate or 
annul any rule attempted to be established on the subject. 2 But, 
notwithstanding all that has been said in favour of this opinion, the 
experience of those competent to decide in the matter, will justify 
the conclusion that instances of the repetition of the disease are 
comparatively rare ; that one attack of true yellow fever serves, if 

1 Traite de la Pneumonie, 324, 325. 

2 R. Jackson, Yellow Fever of Spain, 50 ; Edinb. Journ. lxviii. 497 ; Bancroft's 
Sequel, 42 ; Rush, iii. 87, 88 ; Maclean on Epid. i. 233 ; Pinkard's Notes on W. I. ii. 
257 ; Tullock's Stat, of Brit. Army, 4 ; Labat, ii. 74, iv. 307 ; Arnold, 62 ; Fenner, N. 
0. Journ. v. 206. 



396 PNEUMONIA AND 

not always, at least in the large majority of cases, as a protection 
against reinfection ; that when in the West Indies, and other sec- 
tions of hot latitudes, second attacks present themselves, they most 
usually do so in individuals whose systems, after having passed 
through the disease, have been modified or renovated by a long 
residence in some cold region — or by spending much time at sea — 
or in whom the original attack was mild ; or again among those 
who, after having experienced an attack of the fever in its sporadic 
form, or during the course of a mild epidemic, become exposed to 
an extensive and malignant visitation of the same. Cases of the 
kind, whatever be the circumstances under wTiich they may occur, 
are, I repeat, few in number, and scarcely more frequently encoun- 
tered than are second attacks of smallpox, scarlet fever, and kin- 
dred diseases, the protective power of which is fully recognized. 1 

It is more than probable that those who contend for the frequent 
repetition of the yellow fever in the same individual, will be found 
principally among the advocates of the identity of that and other 
forms of autumnal fevers. If this be correct, the instances of 
second attacks recorded or referred to, may reasonably be supposed 
to have been cases not of true yellow fever, but of ordinary bilious 
remittent fever, and we shall read with less astonishment of the 
individual mentioned by Dr. Potter, of Baltimore, who had the 
disease as many as eight times. Dr. Potter, as also Dr. Eush, Dr. 
McLean, Dr. Pinkard, Dr. E. Jackson, Dr. Bancroft, and others in 
this country and abroad, who speak so confidently of such frequent 
repetitions of the disease as an'every-day occurrence in yellow 

1 Lining, ii. 490 ; Dickson, Phil. Med. and Phys. Journ. iii. 273 ; ib. Essays, 352 ; 
Irving, 31 ; Simons, 21 ; Francis, N. Y. Journ. i. 299; Currie, 15; Hosack, i. 385; 
Townsend, 247 ; Archer, Med. Rec. v. 61 ; Kelly, Am. Journ. Oct. 1847 ; Barton, 
Pep. 21; Cartwright, Rec. vii. 15; Wood, i. 304; Arejula, 191; Fellowes, xxiii. 67; 
Berthe, 836; Gilpin, Med.-Chir. Tr. v. 318; Amiel, in Johnson, on Tr. CI. 269; Pariset, 
97 : Wilson, 73, 74 ; Pym, 29 ; Appendix, 302 ; Rochoux, 38 ; Pugnet, 348, 349 ; Chis- 
holm, ii. 233; Savaresi, 256; H. McLean, 8, 187; Caillot, 249; Gilbert, 76; Dariste, • 
38, 112; J. Clark, 19; Blane, ii. 147, 148; Forry, 205; Williamson, i. 311; Strobell, 
202; Dickinson, 40, 47, 68; Doughty, 183; Copland, Diet. ii. 951; Mitchell, 128 ; 
Chapman, Phil. Med. and Phys. Journ. ix. 130; Seamen, Med. Repos. i. 319; ib. 
Fever of 1795, in Webster's Coll. 40; Blair, 85, 86; Hume, 241 ; Klapp, Med. Rep. vi. 
472; Veitch, 110; Monges, N. A. Journ. ii. 58; Ashbel Smith, Trans, of N. Y. Acad, 
of Med. i. 59 ; Treat, on Yellow Fever of Galveston, 60 ; Davy, Notes on Blair, 85 ; 
Lewis, Fever of Mobile, N. O. Journ. i. 418, ii. 43, iv. 162; McCraven, Top. and Dis. 
of Houston, Texas, Trans, of Am. Med. Assoc, v. 669 ; Jameson, Dublin Journ. of 
Med. Sci. (N. S.) xvi. 358. 



AUTUMNAL FEVERS. 397 

fever regions, are all firm believers in the identity in question ; 
while we shall look in vain, in the writings of those who entertain 
different pathological views, for the admission that such cases 
should be regarded otherwise than as exceptional. But even were 
we to admit that the disease, in all the instances of repeated attacks 
mentioned, whether the second or the eighth, was really the true 
genuine yellow fever, we should not be justified, from that circum- 
stance, in denying the protective power of the disease ; not only 
because such instances are, after all, comparatively rare, but because 
occurrences of an analogous kind are encountered in diseases which 
possess that power in a marked degree. As already mentioned, 
second attacks of smallpox, scarlet fever, and other kindred dis- 
eases, are not unfrequently encountered — nay, it is doubtful whether 
yellow fever repeats itself more frequently than either ; and cases 
are on record in which they have outdone in point of repetition, 
anything that can be related of the yellow fever. Dr. Davy informs 
us, on the authority of a general officer (whose mother was the 
subject), of a case in which the smallpox was repeated eleven times 
in the same person. 1 

Other forms of malarial fever afford, if we may credit the state- 
ments of respectable authorities, protection against reinfection. In 
the West Indies, there are several forms of fever distinct from the 
true typhus icterodes, and which Dr. Copland has denominated 
bilio-mflammatory or ardent fever, and adynamic marsh fever, 
which act as seasoning fevers to Europeans who arrive in hot cli- 
mates ; the former appearing in robust plethoric persons, who have 
emigrated to the West Indies, intertropical Africa, &c, the other 
in those less robust, or who have not been attacked by ardent fever. 2 
Dr. Stevens also recognizes the existence of two fevers independent 
of the true yellow fever, which he denominates African typhus, 
and, like Chisholm, Pym, and some others, regards as a native of 
Africa, One of the other two aforesaid fevers, he designates the 
climate fever. It corresponds to the bilio-inflammatory of Copland, 
and is a seasoning fever, and, as a general rule, is not taken twice, 
unless the individual so attacked has left the West Indies and 
returned again. 3 The Batavian and Edam fever, which, notwith- 
standing some points of similitude with the yellow fever of the 
West Indies, and the occasional occurrence in it of a few of the 

1 Notes on Blair, 86. 2 Diet. ii. 1104. 3 On the Blood, 194. 



398 PNEUMONIA AND 

symptoms appertaining to the latter, cannot be considered as iden- 
tical with it, is also evidently a seasoning fever. 1 

The pernicious fevers of Algeria, France, and other localities — 
the periodic and malarial nature of which cannot be disputed, have 
never, in the experience of Dr. Boudin, attacked the same individual 
a second time. 2 After observing that, with one exception, the exan- 
themata, which occur only once, have a quartan type, Dr. Lacock 3 
says that " it is at least a curious coincidence, that a person who has 
had a quartan ague is not liable to a second attack." Sydenham 
many years ago made the remark, and stated as a fact worthy of 
observation, that if any person be seized with a quartan who has 
had it, though long since, it terminates spontaneously after a few 
fits, of whatever age or constitution he be. 4 After him, Yan 
Swieten, as Dr. Lacock reminds us, expressly stated and insisted 
upon the same fact; and Dr. Wallis, in his note upon the above 
passage in Sydenham, confirms the statement, and remarks that "it 
is known from observation, in the marshes of Essex, the fens of 
Cambridgeshire, and other places where intermittents are ende- 
mial, that those who have laboured once for a series of time under 
this complaint, which will sometimes continue two or three years 
with short intervals, and escape the fatal consequences, will after- 
wards live totally free, or subject only to very slight attacks, which 
spontaneously disappear ; though this is not always the case." 5 Sir 
Gilbert Blane states of the fever of Walcheren, that it is well ascer- 
tained that strangers, if they survive the first attack, become there- 
after much less liable to the endemic intermittents. 6 

Some of the physicians whose views are now under examination, 
will not find fault with me for calling their attention to the fact 
that second attacks of typhoid fever, 7 a disease which doubtless 
arises, in some instances at least, from peculiar malarial sources, or 
at any rate is most certainly localized where these exist, and which 
not a few of them regard as nothing more than a peculiar form of 
autumnal or periodic fever, are seldom encountered. By some of 
them, too, Asiatic cholera is held in much the same light. Let 
them say how many cases of second attacks they have observed in 
that disease. 

1 Johnson, op. cit. 151. 2 Geographie Medicale, 46. 

3 Lancet, 1842, i. 162. 4 Sydenham, Wallis's edit. i. 82. 

5 Ibid. 82. 6 Dissertations, i. 224. 
7 Bartlctt on Fevers, 98. 



AUTUMNAL FEVERS. 399 

Dr. Barker, in his report of the Cork Street Hospital, Dublin, 
states that he has for some time entertained the opinion, that sufferers 
from fever, attended with petechial eruption, if they are not alto- 
gether secured by it from a second attack, are not, at least, so liable 
to it as those who have had no fever of the ordinary kind. And, 
in continuation, he says : " Though I have frequently made the 
inquiry, I have not found a patient in whom this symptom was dis- 
tinct, who had suffered from the same fever on any former occasion. 
The analogy which this bears to other fevers, more especially to 
that which appeared at Gibraltar, and also to some exanthematous 
diseases, lend support to the opinion of its rarely occurring more 
than once in life." 1 

But while the power of exhausting the susceptibility of the sys- 
tem to future attacks appertains to some forms of autumnal fevers, 
as also to several other diseases, which many of the advocates of the 
views under examination have no hesitation in regarding as mere 
modified forms of periodic fevers, it would be wrong to attribute 
the same privilege to all the other forms of these. Experience, in- 
deed, teaches, that however true it may be that the severe and 
malignant bilious remittent of the West Indies assumes, at times, 
the character of a seasoning disease, and guards against the return 
of the same — so long, particularly, as the individual remains in the 
country — the rule is far from being general, and does not apply to 
the common forms of the disease ; for it is a well-established fact, 
that in temperate climates an attack of remittent or intermittent 
fever not only fails to impart perfect immunity to the sufferer, but 
is regarded by accurate and experienced observers as affording no 
protection at all, and even as increasing the liability of the system 
to fresh invasions of the complaint. 2 

If now we inquire how matters stand, so far as concerns pneumo- 
nia, in reference to the exhausting power in question, we shall find, 
that while that disease, and indeed all those of the same class, 
approximate to some forms only of malarial fevers, it differs widely 
from several of the more important ones ; for, like bilious remittents 
and intermittents, but unlike yellow and other fevers mentioned, 
one attack of pneumonia, nowhere and under no circumstances, 

1 Bracken's Rept. in Barker and Cheyne's Acc't of Fev. of Ireland, i. 241. 

2 Ashbel Smith, loc. cit. 58; Dickson's Essays, &c. 344, 345; do. Charleston J. vii. 
840; Simons, 21; Wood, i. 304; Tullock, Statist. 46; Strobel, 203; Parry, Am. J., 
Jan. 1843. 



400 PNEUMONIA AND 

whether in the north or the south, the east or the west; whether 
the case be mild or severe, simple or complicated, affords the most 
remote shadow of protection against the recurrence of the disease. 
So far from its doing so, everywhere we find that persons who have 
laboured under pneumonia, are by that very fact rendered more 
liable to the complaint than they were prior to the attack. Hence, 
second and third repetitions are very frequently observed, especially 
in the same lung. The disease has been noticed ten times in the 
same individual by Chomel ; eleven times by Frank ; sixteen times in 
eleven years by Andral; twenty-eight times by Kush; three, fonr, 
five, seven, and eight times by Grisolle - 1 and there is scarcely a 
practitioner in this or any other country, who has not witnessed 
instances of the kind. 

It is not to be denied that, on this particular point, pneumonia, 
while differing greatly from some of the forms of autumnal fevers, 
allies itself to others which do not possess the power of exhausting 
the susceptibility of the system to future attacks; and the advocates 
of the close alliance and identity of the two diseases may appeal to 
this circumstance in proof of the correctness of their views. But 
on reflection, the reader will, unless I am greatly mistaken, join in 
the opinion that the similarity in question can afford but little if 
any support to the idea of pneumonia being only a peculiar form 
of autumnal fevers. For, if an argument is built upon the circum- 
stance that neither pneumonia nor the forms of malarial fever in 
question afford protection against future attacks of the same, what 
shall we do with the fact that other forms of those fevers possess 
the privilege in question ? The latter fact is not to be ignored ; and 
if the advocates of the identity of pneumonia with periodic fever 
are permitted to adduce in support of their views the absence of the 
exhausting power in both the former, and some of the varieties of 
the latter, no reason can be assigned for refusing to the opponents 
of that hypothesis the liberty of pointing out, in proof of the sound- 
ness of their theory, the existence of that very power in yellow and 
some other fevers, the malarial origin of which is as evident as that 
of common bilious remittents and intermittents. In this way, we 
should have both parties in the controversy appealing to opposite 
peculiarities in different forms of the same class of diseases, to prove 

1 Cyclopedia of Pract. Med. iii. 406; Chomel, Diet, de Meddcine, xvii. 214; Frank, 
Intern. CI. Obs. Select. 96; Andral, Med. CI. 192; Desoteux, Diet, des Sc. Med. xliii. 
376; Grisolle Tr. de la Pneumonie, 111. 



AUTUMNAL FEVERS. 401 

or disprove the identity of these with pneumonia. So far from con- 
ceding to the advocates of the unity in question, the propriety of 
deriving an argument from the similarity or absence of the power 
of exhaustion alluded to in pneumonia, and in common periodic 
fevers, there can be no difficulty in perceiving that the fact of the 
poisons of yellow, and of some other kindred fevers, exhausting the 
susceptibility of the system, must lead to very contrary conclusions, 
and fortify us in the belief of the propriety of establishing a line of 
separation between pneumonia and malarial fevers generally. These 
fevers, as we have seen, are, like other zymotic diseases, the off- 
springs of particular poisonous agents introduced into the system, 
and therein producing special effects ; and the only difference be- 
tween them, so far as regards the exhausting power in question, 
depends on this, that in some forms the morbid poison in its action 
on the system destroys certain materials or principles, the existence 
of which is necessary to enable the latter to be morbidly affected 
by the impress of that poison ; while, in the other case, the poison 
possesses no such destructive effects, and leaves the system suscep- 
tible of being again affected by it. 

While bearing this in mind, the reader must not lose sight of the 
circumstance that this power of exhaustion, though possessed by 
many of the morbid poisons, is not a necessary and indispensable 
attribute of them all ; for among them not a few are found, which, 
while affecting the system in a specific manner, and occasioning 
diseases of a highly and often fatal character, do not impart to 
those who recover the power of resisting their future morbid im- 
press. In this category, we may place a number of the animal 
poisons and venoms. The absence of the same power of exhausting 
the susceptibility of the system to reinfection, cannot, therefore, be 
adduced in denial of the toxical nature of the cause of the particular 
forms of autumnal fever in which it is noticed, and as lending sup- 
port to the belief in the close connection referred to between such 
fevers and pneumonic inflammations. If we refuse to admit the 
toxical nature of those fevers on the score of the absence in them 
of the power in question, and acquiesce for the same reason in the 
propriety of severing them from zymotic diseases with the view to 
class them with pneumonia, we cannot object to rejecting from the 
list of morbid poisons the animal venoms and poison above alluded 
to, and classing the diseases they produce among the phlegmasia 
of the chest. The conclusion in the one case, would be just as 
26 



402 PNEUMONIA AND AUTUMNAL FEVERS. 

reasonable as in the other ; and I close the subject with the remark 
that, in all malarial or autumnal fevers, the introduction of a poi- 
son, whether endowed with that destructive agency or otherwise 
matters not, is necessary to occasion the disease — a circumstance 
very different from what occurs in pneumonia, the production of 
which is in no way connected with the existence of a poisonous 
agent ; and if the latter disease assimilates itself with some forms 
of malarial fevers in this, that, like them, it leaves the system sus- 
ceptible to farther attacks, it differs from them in not being the 
result of a morbid poison, as well as in its phenomena, anatomical 
characters, and other circumstances already dwelled upon; while 
those fevers, though not exhausting the susceptibility of the system, 
present a close analogy to those that possess the privilege of doing 
so, in regard to their toxical origin, their phenomena, their anatomi- 
cal characters, and the laws by which they are governed. Viewed, 
therefore, as a class, malarial fevers — like many other zymotic dis- 
eases — may be considered, so far as concerns second attacks, as 
differing from pneumonia. 



CHAPTER VI. 

PNEUMONIA AND AUTUMNAL FEVERS COMPARED IN REFER- 
ENCE TO THE POWER OF ACCLIMATIZATION — AGES, SEXES, 
AND RACES OF THOSE AFFECTED: PREVALENCE OF THE 
TWO DISEASES AT THE SAME TIME, AND IN RAPID SUC- 
NO PROOF OF IDENTITY. 

The 'power of acclimatization does not extend to 'pneumonia — Still 
more strikingly do autumnal fevers of various forms and grades 
differ from pneumonia, on the score of trie protection afforded 
against attacks of those diseases, by the peculiar organic changes, 
resulting from long habituation to the sensible or insensible quali- 
ties of the atmosphere of particular regions or localities, or to the 
poisonous materials by which that atmosphere may be contaminated. 
That such a protection is thus obtained, to a greater or less extent, 
in regard to all malarial and some other forms of fever, no one who 
has examined the subject with attention will feel disposed to deny. 
By long habituation to infectious localities, and to the high temper- 
ature of hot regions, the system becomes acclimatized, and thereby 
acquires the power of tolerating perfectly and permanently the 
poison, or of eliminating it as soon as received, without succeeding 
reaction. The observation is of old standing. Pliny, nearly twenty 
centuries ago, called attention to the fact, " that they who are sea- 
soned can live amid pestilential diseases," and the statement has 
been confirmed by all subsequent observations. 

Equally well ascertained is it, that the danger of infection among 
strangers increases in proportion to the coldness of their native 
land, or of their accustomed place of residence ; x that protection in 
its entire perfection is only enjoyed by the residents of to was or 
cities subject to the disease; and that the inhabitants of neighbour- 

1 Savaresi, 260; Bally, 268, 334; Dariste, 210; Fontana, 170; Arnold, 26; N. 
Dickinson, 13 ; Blair, 59. 



404 PNEUMONIA AND 

ing, but more elevated and salubrious portions of the country, 
though less prone to the disease than strangers from cold climates, 
are, nevertheless, liable to suffer when they venture in an infected 
place. 1 Not less certain is it, that the protective influence of accli- 
matization is lost by a prolonged residence in cold climates ; 2 that 
the children of the natives of, and acclimatized to, tropical regions, 
do not enjoy the same advantages in regard to protection as their 
parents, 3 but acquire them rapidly as they advance in age ; that the 
residents of some portions of tropical regions suffer to a certain 
extent from the disease, on removing to another and more insalu- 
brious part of the same regions, 4 or even to one differing but little 
in point of salubrity. We find also that individuals acclimatized 
to a yellow fever locality sometimes lose, to some extent, the pro- 
tection they had enjoyed, by a long exemption of that locality from 
local sources of infection, or its being favoured, during several suc- 
cessive summers, with a cooler and purer atmosphere than before; 5 
and that the same results obtain when individuals change their 
residence to places where the effluvia evolved, though not more 
detrimental to health, are of a different nature from those to which 
they were accustomed. 

So far as regards the yellow fever, every medical writer, from 
the days of Towne, Warren, and Pouppe Desportes, whose works 
contain the earliest professional records we possess relative to the 
fevers of tropical climates, has dwelled upon the protective effects 
enjoyed in hot regions by those who are acclimatized to sickly local- 
ities. 6 The decided advantages resulting therefrom is adverted to 

1 Dariste, 37, 38 ; J. Clarke, 22 ; Humboldt, 772, 773; Keraudren, 24 ; Imray, Edin. 
Journ. liii. 94; Ferguson, Med.-Chir. Trans, viii. 144; Bancroft, 268. 

2 Rochoux, 40, 41 ; Maher, 884; Bally, 332, 340; Arnold, 26; Mc Arthur, in John- 
son, 350; R. Jackson, Fevers of Jamaica, 250; H. McLean, 187 ; Pugnet, 345, 346; 
Frost, Med. Repos. xii. 224 ; Dariste, 37 ; Savaresi, 256 ; Bancroft, 268 ; Frazer, Med.- 
Chir. Rev. xiii. 347; Rufz, Med. Exam. iii. 109; N. Dickinson, 12; Veicht, 111, 112; 
Hume, 267. 

3 Musgrave, Med.-Chir. Trans, ix. 106, 107; Rufz, Med. Exam. iii. 106. 

4 Humboldt, 761, 771, 772; J. Clark, 1, 2; Pugnet, 346. 

5 Chervin, Report on Rufz's Mem. 44. 

6 Williams. 51; N. Dickinson, 11, 66; Edin. Journ. xxxvii. 154; Henderson, 5; 
Hume, 237; Wright, Med. Facts, &c. viii. 8; Jackson, Fevers of Jamaica, 250; H. 
McLean, 187 ; Madrid, pt. I. 32 ; Savaresi, 260 ; Bally, 268, 332 ; Dancer, Med. Assist. 
82; Lefoulon, 20; Leblond, 18, 227, 245; Manson, 5; Rochoux, 31 ; Caillot, 13; Che- 
vallier, 3; Pinkard, ii. 472, 1st ed. ; Gilbert, 75, 76; John Hunter, 19; Arnold, 26: 
Bancroft, Seq. 41 ; McArthur, Dis. of Barbadoes, Med. Obs. vii. 326 ; Peixotto, N. Y. 



AUTUMNAL FEVERS. 405 



by Labat, 1 Ulloa, 2 Griffith Hughes, 3 Moreau de St. Mery, 4 Herrera, 5 
Oviedo, 6 and other early, and by all modern, travellers and histo- 
rians ; and among the public at large the reality of the privilege 
was early, and continues to this day to be, viewed as placed beyond 
the possibility of doubt. 

The whole history of yellow fever, as we are told by one who 
has thoroughly investigated the subject, shows that its most sus- 
ceptible subjects in tropical climates are those who have recently 
arrived within its sphere, particularly the inhabitants of northern 
climates, and that the predisposition to an attack increases with the 
degree of the northern latitude from which the stranger has arrived, 
and the shortness of the interval that has passed since he left the 
European for the equatorial region. In illustration of the com- 
parative security of native inhabitants over new-comers, this author 
— Dr. Ferguson — adverts to the experience of the troops at Cape 
St. Nicholas Mole, St. Domingo, among whom, soon after disem- 
barking, yellow fever broke out " at every station and in every 
place." During the earlier part of the residence of the British 
troops there, while all were deeply interested to stop the mortality, 
a census was taken of the inhabitants of the town, exclusive of the 
negro slaves and the white soldiers, when they were found to be 
very nearly equal in numbers. But by the time they had buried 
the original complement of 1,500 men, the inhabitants had not lost 
more than one in thirty of all ages. 7 

Dr. Burr ell states, that " of thirty regiments that arrived in the 
Windward and Leeward Islands, between 1816 and 1848, ten were 
attacked with black vomit fever a very short time after landing ; 
two within three months ; eleven within twelve months ; five within 
two years ; and two within three years of their arrival. Of thir- 
teen regiments, which landed in Jamaica between the years 1816 
and 1834, four were attacked within six months; seven within 
twelve months ; and two within eighteen months. From 1838 to 

Journ. i. 417; J. Clark, 22; Dariste, 21 ; Evans, 276 ; Gillkrest, Cycl. ii. 279; Boyle, 
150 ; Blair, 59 ; Doughty, 65 ; Trans. Am. Med. Assoc, v. 589. 

1 Nouveau Voyage en Amen que, ii. 264. 

2 Voy. Hist, de l'Amerique Meridionale, i. 42. 3 Hist, of Barbadoes, 37. 

4 Loix et Constitutions de Saint Domingue, i. 375. 

5 Historia General de los eckos de los Castellanos in las Islas, &c. de Mar Oceano, 
lib. iii. cap. 15, lib. x. cap. 4. 

6 La Historia General de las Indias, lib. v. cap. 11. 

7 Ferguson's Notes and Recollections, 150. 



406 PNEUMONIA AND 

1848, seven regiments arrived in that island, but the emancipation 
of the negroes permitting the troops to be quartered in the mount- 
ains, a few cases only of black vomit fever appeared within that 
period, in two of them soon after landing." 1 

It is, however, proper to remark that, general as the rule un- 
doubtedly is, it is not universal, but subject to occasional, and, 
according to some writers, more or less frequent exceptions. 2 Phe- 
nomena of like nature are observed in our southern cities — New 
Orleans, Charleston, Savannah, Mobile — where the fever is, as it 
were, endemic, and the heat considerable and of loDg continuance, 
and where the causes of insalubrity assume a character of perma- 
nency. There, as in tropical regions, the natives and long residents 
who have gone through the process of acclimatization remain, with 
few exceptions — principally in times of severe epidemics, when the 
cause is very powerful — free from the disease, which exercises its 
effects among strangers ; so exclusively, indeed, as to have acquired 
in Charleston, and some other places, the name of the stranger's 
fever. There, as within the tropics, true and effective acclimatiza- 
tion is enjoyed only by the residents of localities liable to the dis- 
ease, and not by those who reside in country districts, or even in 
the suburbs of infected cities. Like "West Indians, the acclimatized 
inhabitants of our southern cities lose the protection they possessed 
by a prolonged residence in some northern place, or in a rural dis- 
trict of the same region ; while their children, and those of the 
natives, are as prone to the disease as strangers themselves. 3 

1 Second Report on Quarantine, 9, Lond. 1852. 

2 Griffith Hughes, 37; Chevalier, 6; Gillkrest, 279; Pugnet, 331, 346; Caillot, 
142; Bally, 332; Savaresi, 134; Rufz, Examiner, iii. 109; Chervin, Rept. on do. 32, 
44; Musgrave, Med. Ch.-Tr. ix. 106 ; lb. Med. Ch. R. and J. iv. 981 ; Imray, Ed. J. 
liii. 79 ;■ Stevens, 195, 201 ; Chisholm, ii. 234 ; Bancroft, Seq. Ferguson Med. Ch. Tr. 
viii. 139-150; Jackson, 11, 35; lb. Outlines, 63; Lempriere, ii. 29; Hunter, 19; 
Hillary, 126; Catel, 6; Desportes, i. 192; Humboldt, 771,772; Dancer, 82; Guyon, 
28 ; Warren, 4 ; Furlong, 290 ; Barry in Boyle, 270. 

3 Gros. Rept. 7; Girardin, 49, 51; Thomas, 1st ed. 77; 2d ed. 22; Michaud, Voy. 
a l'ouest des monts Alleganys, 5 ; Townsend (for fever of St. Augustin), 361 ; Ticknor, 
N. A. J. iii. 218 ; Barton, Lecture on Acclimatement, 3 ; Essay, 21 ; Strobell, 139, 160 ; 
Bancroft, 1 88, 192 ; Dickson, Phil. Med. and Phys. J. iii. 257; Ramsay, Rev. of Improv. 
39; lb. Med. Repos. iv. 218; lb. viii. 366-395; lb. Hist, of S. Car. ii. 88; Drayton, 
Rev. of S. Car. 27, 28; Dickson, Bell's J. iv. 112; Simons, 13; Rept. on Fever of 
N. O. of 1819, pp. 35 and 43 ; lb. on Fever of 1839, p. 324 ; lb. Fever of 1820, p. 6 ; 
Monette, Western J. iv. 339 ; Seagrave, Med. and Phil. Reg. iii. 442 ; Waring, 59 ; 
Daniel, 63; Dupre\ Hays's J. ii. 382 (N. S.); Harrison, N. O. J. 130; Dickson, Es- 
says, 343 ; Lewis, Fev. of Mobile, N. O. J. i. 417; v. 43. 



AUTUMNAL FEVERS. 407 

The same, though, to a more limited extent, is found to be the 
case in various of our less southern cities — as Natchez, Vicksburg, 
Grand Gulf, and Norfolk, where the protection afforded by acclimati- 
zation is not sufficiently effective to limit the inroads of the fever to 
strangers. For there the natives and long resident, while less liable 
than the latter, are, nevertheless, far from being entirely exempt. 1 
There also, as well as in the cities of our Middle States and in Eu- 
rope, where nativity or long residence affords no protection, the in- 
habitant of more southern or tropical localities, in which the yellow 
fever prevails endemic-ally, and assumes often the epidemic charac- 
ter, exposes himself with impunity to the causes of the disease ; 2 
and there also, as in tropical regions, among the unacclimatized, 
the disease is less apt to attack natives of southern than those of 
northern climates — less Spaniards, Portuguese, and French, than 
Eussians, Germans, Swedes, &c. 

Nor is it less true that acclimatization extends its influence, 
though less effectually and less generally, to some other forms of 
malarial fevers. In England, says Dr. Pinkard (ii. 480), " the har- 
vest-men and strangers who go into the fens of Kent and Lincolnshire 
in the autumn, are more readily attacked with the endemical fever 
of those provinces than the inhabitants who constantly reside in 
the atmosphere which causes it." The protection afforded by accli- 
matization against endemic remittent is found to be enjoyed in this 
country, often giving entire immunity, and generally lessening the 
violence of the disease. Dr. Coventry mentions it in reference to 
our lake fever. 3 It is also recognized as regards the fever of our 
Southern States — Georgia and South Carolina. 4 

The term acclimatization, as we are told by Dr. Fenner, is just as 
familiar to the inhabitants of all the southern portion of the Missis- 
sippi Valley as it is to the citizens of New Orleans, " and is used to 

1 Merrill Chapman's J. ix. 246 ; Cartwright, Kecorder, ix. 15 ; Taylor and Hans- 
ford, Med. Rep. iv. 206 ; Selden and Whitehead, ib. iv. 334 ; Archer, Recorder, v. 61 . 

2 Bancroft, 266; Berthe, 167-169; Fellowes, 59; Gilpin, Med.-Ch. T. v. 317; 
Pym, 25; Arejula, 183, 330, 446; Pariset, 14, 15; Caisergues, 200, 201; Rochoux, 
123 ; Shecut, 108; Seamen, Fev. of 1795 in N. Y. 7 ; A. Hosack, 10 ; Warren, in Tyt- 
ler, 501 ; Potter, 162 ; Drysdale, Med. Mus. i. 39, 40 ; Dalmas, 100 ; Ramsay, Edin. 
J. yiii. 429; Deveze, 55; Rush, iii. 80; Currie, 12; Ib. Barton's J. ii. 38; Cathrall, 
6 ; Nassy, 38 ; Carey, 67 ; Condie and Folwell, v. vi. ; Caldwell, Fever of 1805, 79 ; 
Facts and Obs. by College of Phys. 19 ; O'Halloran, 119 ; Bartlett, 401. 

8 Address, 42. 

* Pendleton, Charleston J. vii. 451 ; Lewis, N. 0. J. i. 323. 



408 PNEUMONIA AND 

express the same idea, viz. that persons coming from a northern 
climate and settling there, are very liable to have attacks of fever 
during the first two or three years, but afterwards become quite 
exempt. 1 The same power of resistance to the action of disease 
by the acclimatized has long been recognized in other countries — 
in South America, in Italy, &c. 2 Lancisi says that they who are 
born and reared in the neighbourhood of marshes enjoy good 
health in an unhealthy atmosphere. And children can, by degrees, 
be accustomed to take considerable doses of the poison, beginning 
with small ones at first. " By this power of habit does it happen 
that man can live upon the small islands in those ponds and lakes ; 
and that even the floating islands which the winds drive about 
from place to place, have their human inhabitants. For Secundus, 
in his description of the Lake of Vadimon, declares he has seen 
them. P. Cabseus has observed them in the marshes of Ferrara, 
and I myself have seen them in the Alban Lake." 3 

Dr. A. Brown, whose observations have reference evidently as 
much to the common remittent as to the yellow fever of tropical 
climates, after stating that a soldier, or stranger, cannot be con- 
sidered inured to such climates by a residence of less duration than 
from three to five years, remarks that if the latter period be adopt- 
ed, as affording a greater probability that a regiment has passed 
through at least one epidemic season, on turning to table 76, p. 92, 
of the Statistical Eeport, we find that the average mortality, during 
the five years of service, was in the ratio of 147.7 per 1,000, whereas, 
in the second five years, it was 104.7 per 1,000 of the strength. If 
we now examine table 77, p. 93, from which the great epidemic 
years are excluded, we find that the mortality in the first five years 
of service was 102 per 1,000, and in the second five years 82 per 
1,000 of the strength. From this we perceive that the immunity, or 
advantage enjoyed by the acclimatized, is not confined to epidemic 
years, though in such it appears to be about twice as great as in 
ordinary years ; the diminution of the mortality, amounting in the 
former to four, and in the latter to two per cent, of the force 
respectively. 4 

1 Southern Med. Rep. i. 32. 

2 Weatherham, Celle Hyg. des Pays Chauds, 76 ; Macculloch on Remittent Fever, i. 
10, 11 ; Johnson on Trop. Climates, 151. 

8 De Nox Pal. Effl. lib. i. cap. v. 21. 

4 Second Report on Quarantine, 294, 295. 



AUTUMNAL FEVEES. 409 

The following remarks of Sir Gilbert Blane on this subject, 
though applying only to the Walcheren fever, may be appropriately 
introduced here: "One of the most important circumstances in 
the operations of marsh miasmata on the human body, is the power 
of habit in mitigating its influence. The natives are a robust 
people ; they are of a very wan and sickly hue, with flaccid flesh, 
and have all suffered more or less from the bad air which they 
breathe. The children of both sexes are very subject to glandular 
and abdominal complaints; and the adults, particularly those of 
the lower orders, have all of them, sometime or other in the course 
of their lives, laboured under the endemic intermittent. They are, 
however, infinitely less subject to intermittent fevers than strangers." 
" These strangers are also variously affected, according to the dis- 
trict from which they come. It was found, that of the British 
troops, the natives of mountainous countries and dry soils, such as 
the Highlands of Scotland, were more frequently affected than the 
natives of flat and moist districts, such as Lincolnshire." Sir Gil- 
bert mentions the case of a French regiment, " which suffered in 
the second year of its being there only one-half of the sickness and 
mortality which it suffered the first year, and hardly suffered at all 
the third." 1 Monfalcon informs us that the same fate attends the 
inhabitants of the high and healthy localities in the vicinity of the 
fenny districts of the Bresse, who visit the plains in quest of work 
during harvest; 2 and similar statements are made by Fodere in 
regard to the peasantry of Eomagna, Modena, and Ferrara. 3 

From all the accounts that have been transmitted to us of the 
sickness and mortality of French troops in Algeria, as well as of 
the results — in a sanitary point of view — of the colonization of 
that country, we learn, that the Europeans, from the north 
particularly, experience great difficult}^ in becoming acclimatized 
there, and that their chances of success in that respect are, to say 
the least, extremely precarious. 4 Diseases — miasmal fevers par- 
ticularly — carry off a large number of the troops ; a larger number 
are soon invalided, and the rest must, sooner or later, be sent back 
to France to renovate their constitutions. While such is the result 
among the European troops, the natives of the country, and the 

1 Kept, on Mission to Walcheren, Dissertations, i. 223, 224, 225. 

2 Traite des Marais, 196. 3 Med. Led. v. 167. 

4 Perier, An. d'Hygiene, xxxiii. 307 ; Boudin, ib. xxxvi. 381 ; Maillot, Fievres Int. 
265 ; Haspel Mai. de l'Algerie, i. 78. 



410 PNEUMONIA AND 

Arabs enrolled in the army, and doing duties similar to those 
assigned to the former, remain free from fever, or take it in its 
mildest forms. Similar results are obtained along the shores of 
the Eed Sea; for while the natives are exempt from the fevers of 
the country, and individuals of the Inclo-Ethiopian race easily be- 
come inured to the climate, the Europeans are with extreme diffi- 
culty acclimatized. 1 

Chomel and other writers state that typhoid fever attacks more 
readily those who have been only a short time in Paris, while it 
in a great measure spares the natives of that city. It appears from 
a table published by Dr. Davidson, 2 that among 568 eruptive cases 
of typhus, in whom this point was ascertained at Glasgow ' Fever 
Plospital from November 1, 1838, to November 1, 1839, 176 were 
natives of that city, and 392 were strangers ; 206 of these stran- 
gers had resided in Glasgow only from one day to two years, and 
186 from two to twenty years and upwards. Dr. D. draws the 
following deductions : 1. That strangers are more liable to become 
infected with typhoid fever than native residents. 2. That the 
majority of strangers are infected within a comparatively short 
period of their residence in Glasgow. 3. That a minor portion of 
strangers, like the natives of Glasgow, may escape infection for 
many years, and yet be afterwards attacked. 3 

In 1851, typhoid fever prevailed epidemically at Montpellier, 
especially among the troops of the garrison. It was principally 
rife among those who had not been long in the place. So far as 
civilians were concerned, it more - generally attacked workmen 
going the rounds of France (faisant leur tour de France), and 
recently arrived, as also people from the country who had come to 
work at the crops and the vintage ; in a word, the disease selected 
its victims among individuals unacclimatized to the place. 4 

Having established the fact of the immunity — complete or par- 
tial — obtained from the action of the causes of autumnal, yellow, 
and other fevers, by long residence in malarial and infected locali- 
ties, I am prepared to ask what analogy there exists in that respect 
between those fevers and pneumonia. In regard to the latter, it is 
undoubtedly true, as we have seen, that it prevails more frequently 

' A. Roche, An. d'Hyg. xxxiii. 36. 

2 Thackeray, Prize Essay on the Causes of Feyer, 68. 

3 See also Bartlett, 102. 

4 Anglada, Traits de la Contagion, i. 124. 



AUTUMNAL FEVERS. 411 

in some orders of climates than in others ; but whatever be the extent 
of its prevalence, it is not less certain that, wheresoever it does show 
itself, no class of the population is exempt from its attacks. Accli- 
matization exercises no influence in that respect ; natives and long 
residents are as subject to it — individual constitutions, tempera- 
ments, idiosyncrasies, habits of exposure to atmospheric vicissi- 
tudes, and other circumstances being the same — as strangers and 
new residents. 

Pneumonia and autumnal fevers affect different races. — The two dis- 
eases do not differ less essentially in regard to the force with which 
they affect the several races. It can scarcely be necessary to re- 
mark, that in all countries subject to malarial fevers generally — 
whether the true and genuine yellow fever, or ordinary autumnal 
or periodic fever — the black race is to a greater or less extent ex- 
empt from the disease. So far as regards the former fever, the 
immunity enjoyed by negroes born and raised, or acclimated, in 
countries where the disease is endemic — the West India Islands 
and the coasts of Mexico, and Southern America — and especially 
by the natives of Africa, has been noticed and recorded by almost 
every writer. This immunity they possess in much greater perfec- 
tion than the whites born, bred, or acclimatized in the same locali- 
ties; and hence may be supposed to owe a large share of it to the 
peculiarity of their organization. Few among them take the fever ; 
and those that do so, have it generally, though not universally, in 
the mildest form. 1 If, like the whites, they occasionally lose this 
protection by a prolonged resideuce in cold climates, and take the 
disease on their return within the tropics, the occurrence is less 
frequently noticed among them, and the attack is of a milder cha- 

1 Custin, in Duncan's Com. v. 149 (Am. ed.) ; Moseley, 146; Lempriere, ii. 29 
Bancroft, 51, 270-272; Jackson, Fevers of Jamaica, 250; Hunter, 20, 308; Pugnet 
346, 347 ; Savargsi, 256-258 ; Frost, Med. Repos. xii. 223 ; Rufz, Med. Examiner 
iii. 129 ; lb. Chervin's Rep. 30 ; Ferguson's Med.-Ch. Trans, viii. 121 ; lb. Med.-Ch 
Rev. Jan. 1840, p. 300; lb. Recol. 142; H. McLean, 187; Humboldt, 772; Hume 
237, 238 ; Chisholm, i. 142, 225 ; Bourgeois, Maladies de St. Domingue in Voy. Inte 
ressants, &c. 417 ; J. Clarke, 3 ; Caillot, 14 ; Manson, 5 ; Bally, 269, 303-305 ; Ar 
nold, 34; Dickinson, 12, 48; Evans, 276; McWilliam's Niger Exped. 128; lb. Fev, 
of Boa Vista, 93, 94; Doughty, 50; Warren, 14; Wright, Med. Facts, &c. vii. 8 
Henderson, 7 ; Bryson, 54 ; Pinkard, ii. 484 ; Copland, iii. 151 ; Leblond, 18, 245 
McCabe's Rep. on Dis. of Warm Climates, 43 ; Diction de Med. xix. 151. 



412 PNEUMONIA AND 

racter j 1 and if blacks removing there from northern climates suffer 
from the disease, sometimes even in its most aggravated forms, 2 the 
effect is far less frequently observed among them than among the 
whites. 

In our Southern States, the blacks have always exhibited the 
same superiority in regard to immunity over the whites — subject, 
however, to the same modifications — not only in those sections of 
country or in cities where the protection afforded to the latter by 
acclimatization is very general, if not entire, 3 but in those places, 
as Natchez, Washington (Miss.), Norfolk, &c, where that protection 
is comparatively limited. 4 In our Middle States, the blacks have 
usually — though not always — escaped entirely, and among the few 
affected, the disease has almost invariably assumed a mild and 
tractable character. For proof of this, I confidently appeal to the 
records of the epidemics by which this city has been visited; 5 while, 
if we cross the Atlantic, and inquire how matters stand in that 
respect in the cities of Spain and in Leghorn, we shall find that 
there also the blacks have almost universally escaped. 6 

Nor is it less a fact placed beyond dispute, that blacks are much 
less liable than whites to other forms of miasmal fevers, and that, 
when attacked, they have the disease in a milder form. This com- 
parative unsusceptibility was noticed in the West Indies from the 
period of the earliest introduction there of negroes. It did not 
escape the attention of Herrera (lib. 3 and 10), and other of the 
early historians, whose observations on the subject have been con- 
firmed by every subsequent writer on the climate and diseases, not 
only of those Islands, but also of every other portion of tropical 
regions. " The negro," says Dr. Ferguson, " may also be said to 

1 Jackson, Dis. of Jamaica, 250 ; H. McLean, 187 ; Lempriere, ii. 29 ; Bancroft, 
176 ; Savar6si, op. cit. ; Gillkrest, Cyclop, ii. 279. 

2 Frost, op. cit. 22-4, note ; Ferguson, Bell's J. iii. 14. 

3 Lining, Essays and Obs. Phys. and Literary, ii. 409; Ramsay's Hist. S. C. ii. 85; 
Simons, 14; lb. Address, 12; Daniel, 65; Thomas, 77; Chalmers, i. 39; Seagrave, 
Med. and Phil. Reg. iii. 420 ; Fever of N. 0. in 1839, in Rev. Med. for 1840, 325 ; 
Ticknor, N. A. J. iii. 218 ; Dickson, 345 ; Lewis, N. O. J. i. 416 ; Bartlett, 345. 

4 Cartwright, Rec. 9 ; Selden and Whitehead, Med. Repos. iv. 335 ; Merrill, Chap- 
man's J. ix. 246 ; Archer, Recorder, v. 61 ; Monette, Am. J. i. 245 ; Hogg, Western 
J. i. 413-416 ; Valentin, 90. 

5 Rush, iii. 81; Caldwell, Memoirs, 210; Cathrall, 6; Currie, 13, 14; Wood, i. 
307; Deveze, 108, 109; Folwell, 57; Carey, 85. 

6 Berthe, 167; Caisergue, 191-200; Burnet, 242; Rept. of the Med. Acad, of 
Barcelona, 23 ; Pariset, Fievre de Barcelone, 542. 



AUTUMNAL FEVERS. 



413 



be fever proof; and the marshy savannas, which lie low and 
scattered and unventilated, prove to him the most healthful abode.* 
From peculiarity of idiosyncrasy, he appears to be proof against 
endemic fevers. To him marsh miasmata, which so infallibly de- 
stroy our white soldiers, are in fact no poison. The warm, moist, 
low, and leeward situations, where these pernicious exhalations are 
generated, prove to him congenial in every respect. He delights 
in them; for he there finds life and health, as much as his feelings 
are abhorrent to the currents of wind that sweep the mountain tops, 
where alone the whites find security against tropical diseases; but 
the black, when placed there, is almost infallibly struck with the 
bowel and heart complaints which prove so fatal to him." 1 

The comparative average prevalence of fever among the European 
and black troops of the British army in the West Indian and 
African commands, and the like mortality from the same disease, 
afford a striking illustration of the difference of susceptibility in 
question. Thus, we find that, during a period of twenty years, 
from 1817 to 1836, inclusive, the result was as follows: — 



Strength. 



Fevers. 



Deaths. 



Jamaica Command. 








Whites . 


51,567 


46,922 


5,253 


Blacks . 


5,729 


634 


47 


Bahamas. 








Whites . 


535 


506 


85 


Blacks 


7,102 


2,260 


40 


Honduras. 








Whites . 


320 


221 


27 


Blacks 


4,356 


1,100 


19 


Windward and Leevjard. 








Whites . 


. 86,661 


62,163 


3,195 


Blacks 


. 40,934 


6,856 


190 


Mauritius. 








Whites . 


. 30,515 


4,707 


53 


Blacks 


1,395 


121 




Sierra Leone. 








Whites . 


. 1,843 


2,600 


756 


Blacks 


7,581 


405 


18 



1 Ferguson's Recollections, Black Troops in the W. I. 207, 209. See also McCabe, 
op. cit. 43. 



414 



PNEUMONIA AND 



The following table will show the comparative ratio of mortality 
from the disease, per 1,000 of mean strength, in the various West 
India Islands, and other commands : — 

Windward and Leeward Islands. 

English Guiana 

Trinidad 

Tobago 

Grenada 

St. Yincent 

Barbadoes 

St. Lncia 

Dominica 

Antigua 

St. Christopher 

Average of whole command 

Jamaica 
Bahamas 
Honduras . 
Sierra Leone 
Mauritius 
Ceylon 

In all those localities, we find the average number of fever cases 
among white troops far exceeding that among the blacks, while the 
mildness of the disease among these is evinced by the smallness of 
the mortality they suffered, compared to that among their Cau- 
casian comrades. In speaking of the sickness of the British troops 
in the Sierra Leone command, Major Tullock says: "Fatal as the 
fevers of this colony have proved to the whole troops, the blacks 
have been but little affected by them ; indeed, the attacks have been 
fewer, and the deaths have not materially exceeded the proportion 
among an equal number of white troops in the United Kingdom or 
other temperate climates. Though fevers are much more frequent 
and fatal among the whites than in the West Indies, the reverse is 
the case with the blacks." 1 By another writer, Dr. Bryson, we are 
told (p. 22), that the natives of Fernando Po are a healthy, athletic 
race of people, yet this island is more detrimental to health than 



Whites. 


Blacks 


52.2 


8.5 


61.6 


3.2 


104.1 


8.6 


26.3 


4.8 


11.2 


.9 


11.8 


3.8 


63.1 


5.2 


19.3 


7.7 


14.9 


1.7 


12.1 


10.5 


36.9 


4.6 


101.9 


8.2 


159.1 


5.6 


81.0 


4.4 


410.2 


2.4 


1.7 


0.0 


25.7 


1.1 



Dis. and Mort. of the British Army (Western Africa), 16. 



AUTUMNAL FEVERS. 415 

any spot in the known world ; even the Africans from the continent 
are always sickly here. Of thirty white mechanics who arrived 
in November, 1827, all had the fever in a very short time; the 
number that died cannot be ascertained. A few were invalided, 
and five only remained in June, 1828 (pp. 22, 69, 70). 1 The reader 
is doubtless already conversant with the universal exemption of the 
Kroomen, not only from the common remittent of the coast, but 
from every deadly fever, as a circumstance rendering them of ex- 
treme utility to the coast squadrons, and to all traders. 

The negroes of our Southern States are but little subject to ma- 
larial fevers; and, while on the rice plantations of Georgia and 
South Carolina, the white cannot reside for fear of the country fever, 
the negro works with impunity, exposed to the rays of the broiling 
sun, and to the humidity of the flooded fields. 2 Dr. Ketchum, in a 
report on the topography, sanitary condition, and vital statistics of 
Mobile, says of the slaves owned by the Creole population : " They 
seem to be entirely exempt from the attacks of yellow and bilious 
fevers." 3 Another writer, Dr. Pendleton, of Georgia, remarks: 
" That the African is less susceptible to malarious influences than 
the white, I have believed from general observation heretofore. 
Although more exposed to the cold dews and hot sun of autumn, 
as well as having more filth about their habitations, they seem to 
be less liable to periodic fevers, and more readily recover than the 
white." In illustration of this, Dr. P. shows that, in the county he 
resides in, the number of idiopathic fevers among the whites greatly 
predominates over that among the blacks ; being in the proportion 
of 14.5 to 10.4 4 After remarking that congestive fever prevailed 
epidemically in his neighbourhood, Dr. Lewis, of Mobile, says: 
" There were, in my professional circle, two blacks to one white ; 
yet I did not see a single case of congestive fever in a negro, nor 
did I hear that any died of the disease in that section of country. 
I have made inquiries of several medical gentlemen who have long 
been practising in the country; their experience does not materially 
differ from mine ; the fact is, that the remarkable exemption from 
yellow fever, which this race enjoys, extends in a great measure to 

1 See also Daniell's Topography of the Coast of Guinea, 134. 

2 Daniel, 64, 65 ; Wood, i. 240-267. 

3 Fennei-' s Southern Med. Rept. ii. 307. 

4 General Report on the Topography of Middle Georgia, Charleston Journ. vii. 455. 



416 PNEUMONIA AND 

all the malarious fevers of hot climates ; they may all have inter- 
mittent and light bilious fevers, as well as the milder grade of yel- 
low fever ; but it is only under extraordinary circumstances that 
these diseases affect them so seriously as to cause death." 1 Dr. 
Lewis remarks, that any one who weighs calmly all the influencing 
circumstances by which plantation negroes are beset, the vicissi- 
tudes of heat and cold to which they are hourly exposed, such as 
running from the fields during a shower of rain, sleeping in wet 
clothes, on a cold bluff, or earthen floor, from which they arise with 
a pain in the head, or cold stiffened limbs; their inattention as to 
the preparation of their food, which they eat in a crude, half-cooked 
state, it will be found that these, and not malaria, are the chief 
causes of the mixed undefmable fevers, dysenteries, and diarrhoeas 
that annoy them. 2 

Now, if with all these facts before us as to the insusceptibility 
of the African race to malarial fevers, we inquire into the preva- 
lence of pneumonic inflammation among them, we shall find but 
little calculated to justify the idea of the close alliance of the two 
diseases ; for experience teaches, that the blacks are as subject as 
the whites to pneumonia, if, indeed, they are not more so. 

Dr. Kobert Jackson, whose authority no one will attempt to 
impugn, says of pneumonia: "It is the most common form of dis- 
ease that occurs among the transplanted natives of Africa, whether 
such as are enrolled in the lists of the army, or such as are reserved 
for field labour ; particularly in islands of a dry air and broken 
surface." 3 

In illustration of this, let the reader examine the results ob- 
tained among the African portion of the British army, in tropical 
climates, and compare them with those referred to relatively to 
fevers, and he will at once convince himself of the correctness of 
the statement. 

1 Lewis on the Yellow Fever of Mobile, N. 0. Journ. i. 417 ; Duperier, ib. vii. 575 ; 
Grier, N. 0. Journ. ix. 430. 

2 In a releve of 1,036 cases of malarial fever occurring from 1843 to 1848, and fur- 
nished by Dr. Eoling, in a report on the epidemics of Alabama, there were 671 whites 
and 365 blacks and mulattoes. — Trans. Am. Med. Assoc, y. 425. 

3 Sketch, ii. 83, 84. 



AUTUMNAL FEVERS, 



417 







Aggregate 


Cases pneu. 


Deaths. 


Ratio of case 






strength. 


and pleu'y. 




in 1,000. 


Jamaica command, 1817-36. 








Whites . 


. 


51,567 


736 


15 


13.4 


Blacks . 


. 


5,729 


75 


17 


13.1 


Bahamas. 












Whites . 


. , 


535 


3 


2 


5.6 


Blacks . 




7,102 


176 


15 


24.6 


Honduras. 












Whites . 


. 


320 


2 




6.24 


Blacks . 


. 


4,356 


43 


3 


9.7 


Windward and Leewar 


d. 








Whites . 


. 


86,661 


1,975 


113 


20.5 


Blacks . 


. 


40,934 


1,823 


160 


44.5 


Mauritius. 












Whites . 


. 


30,515 


726 


39 


23-8 


Blacks . 


, 


1,395 


30 


2 


21-6 


Sierra Leone. 








. 




Whites . 


. 


. 1,843 


15 


1 


8.14 


Blacks . 


• 


7,581 


81 


12 


10.69 


The freque 


ncy of pi 


leumonia and kindred c 


omplain 


ts among; t* 



blacks of tropical climates, has, indeed, been noticed time after time, 
and recorded by the best authorities; 1 and has not less attracted 
attention in this country, whether the disease appear in its ordinary 
inflammatory form, or in that denominated pneumonia typhoides. 2 
In middle Georgia, as shown by Dr. Pendleton, while the diseases of 
the respiratory organs prevail among the whites in the proportion 
of 13.8 per cent., the same diseases extend among blacks at the 
rate of 28.0 per cent. 3 Dr. Lewis, in like manner, represents the 
various forms of pneumonia as being particularly prevalent among 
the negroes of the South, especially in Middle and South Alabama. 4 
" Pneumonia without subjective symptoms," says Dr. Cartwright, 
" is very common among them (the blacks). Intercurrent pneu- 
monia is more common among them than any other class of people. 



1 Desportes, i. 5, 33, 92, ii. 273; Dazille, 113; Leblond on Fever, 77; Levacher, 
39; Campet, 210, 211 ; Daniell, Topog. of Gulf of Guinea, 53, 94; Bajon, Malad. &c. 
de Cayenne, i. 73. 

2 Fenner's Southern Med. Repts. ii. 432 ; Charleston Med. Journ. vi. 838. 

3 Fenner's Repts. i. 335. 4 Med. Hist, of Alabama, N. O. Journ. iv. 33. 

27 



418 PNEUMONIA AND 

It is met with in typhoid fevers, rheumatism, and hepatic derange- 
ments, to which they are very liable in the coid season." 1 Accord- 
ing to Dr. Harris, of Alabama, negroes were attacked, during an 
epidemic of pneumonia which prevailed in Wetumpka, in 1851, in 
"somewhat greater proportion than the whites, and among the 
former the mortality was decidedly greater than among the latter." 2 
Dr. Grier has also called attention to the same circumstance, and 
remarks, " that the negro is more liable to pneumonic attacks than 
the white race, and the complaint proves more fatal to them." 3 

Difference of susceptibility of the two sexes. — We are scarcely less 
justified in seeking for proof of dissimilarity between the two dis- 
eases in the difference of liability of each of the two sexes. As 
regards pneumonia, males may furnish generally a larger number 
of cases than females, and the disease in them may assume fre- 
quently its most severe character. But there are facts sufficient on 
record to warrant the conclusion, that this greater prevalence of the 
disease in the first-mentioned sex is not the result of an inherent 
susceptibility ; but is due, when it occurs, to a series of fortuitous 
and modifying causes; more particularly to the circumstance that 
males — owing to the nature of their avocations and mode of life— «- 
are usually more exposed than females to the causes of pulmonary 
inflammation ; and that in places where exposure is equal in both 
sexes, the disease manifests itself as frequently in the one as in the 
other. On this subject, statements, for which we are indebted to 
Grisolle, 4 Chomel, 5 Williams, 6 Valleix, 7 and others, can leave no 
doubt on the mind of the unbiased inquirer, so far as regards 
Europe. For, besides that in rural districts, where women are as 
much exposed as men, the disease does not manifest itself more fre- 
quently in one sex than in the other; in prisons, for example, 
where the material conditions of life are similar for all the inmates, 
the number of females attacked equals that of males. Nor should 
it be forgotten that among children, who are exposed to the same 

1 On the Philos. of the Negro Constitution, N. 0. Journ. ix. 205. 

2 Rept. on the Epid. of Alabama, Trans, of Am. Med. Assoc, v. 373 ; see also Drake, 
N. 0. Journ. i. 584. 

3 N. 0. Journ. ix. 430. 4 Op. cit. 114, 
5 Diet, de Med. xxv. 161. 6 P. 289. 

7 Guide du Med. Prat. ii. 259. 



AUTUMNAL FEVERS. 419 

influences, the disease has usually been found to bear with equal 
severity on the two sexes. Similar observations have been made 
in this country and elsewhere. 

In regard to malarial fevers of various grades or varieties, from 
the simple intermittent to the deadly and malignant yellow fever, 
we arrive at different conclusions. In these, males, excepting in 
some epidemics mentioned by Musgrave (106), Catel (10), Eufz 
(32), and under circumstances of a special kind, are more frequently 
affected than females ; and, as a general rule, it may be stated that 
when these are attacked, they have the disease in a milder form. 
That this comparative immunity on the part of females may, in 
some mensure, be due to their more temperate habits, and to their 
being usually less exposed to the deleterious influence of night air, 
or, perhaps, as is presumed by Copland, to the state of the female 
constitution during the period of uterine activity, is doubtless true ; 
but it is equally certain, that, after making every possible allowance 
for the efficiency of these causes of resistance, we still find enough 
to convince us that females are far less obnoxious to the impression 
of the febrile poison than individuals of the other sex. Speaking 
of paludal fevers generally, Dr. Williams remarks that in the West 
Indies, in civil life, a woman is esteemed twice as good a life as a 
man, and he adds that " in barracks the same difference of liability 
is observed between the sexes." 1 The same fact is pointed out by 
other writers in reference to all those fevers conjointly, 2 as well as 
by those who have described the ordinary forms of the disease — 
intermittents and remittents — in France, Africa, Germany, and Italy. 3 
In 1,036 cases reported by Dr. Boling, of Alabama, there were 585 
males and 451 females. 4 

In yellow fever, the difference of liability and intensity has been 
noticed both in intra and extra tropical climates. In the West 

1 Morbid Poisons, ii. 456. 

2 Pinkard, ii. 476 ; Hume, 237 ; Arnold, 34 ; Williams, 51 ; Henderson, 4 ; Madrid, 
pt. i. 32 ; Copland, iii. 139. 

3 Ram el de Pinfluence des marais sur la Sante de l'homme, Marseilles ; Foder6, on 
Epidemics; Hufeland, Journal der prakt, June, 1811; Eisenmann, Der Vegetation 
and Exlanger, 1835. 

Ramel remarks: "Women are much less subject to the disorders of marshy 
localities. We have noticed this fact on the coasts of Africa, and several of our 
friends who resided at Cayenne, have assured us that in that colony more than one 
female has had six husbands." 

4 Tr. Am. Med. Assoc, v. 425. 



420 PNEUMONIA AND 

Indies it was observed and is dwelled upon by Desportes, 1 Moseley, 2 
Leblond, 3 Blane, 4 Pugnet, 5 Poissoniere, 6 Bally, 7 Savaresi, 8 Jackson, 9 
Hunter, 10 Trotter, 11 Humboldt, 12 Caillot, 13 Dariste, 14 Dickinson. 15 

In this country, the same circumstances haye been recorded by 
Deveze, 16 Push, 17 Carey, 18 Barnwell, 19 Condie and Folwell, 20 Cald- 
well, 21 Valentin, 22 Drysdale, 23 A. Hosack, 24 Thomas, 25 Townsend, 26 
Simons, 27 Waring, 28 Hogg, 29 Cartwright, 30 Perlee, 31 Merrill, 32 Archer, 33 
Gros, 34 Kept, of 1ST. 0. Fever of 1819, 35 ih of 1839, 36 Bartlett. 37 

In Europe, also, similar observations have been made by Arejula, 38 
Berthe, 39 Fellowes, 40 Louis, 41 Bally, 42 Gillkrest, 43 Caisergue, 44 Pal- 
loni. 45 

I am not aware that the facts hitherto published, regarding the 
susceptibility of the sexes to typhoid fever, are as yet sufficiently 
numerous to warrant us in drawing any certain conclusions from 
them. In some of the hospitals and cities of Europe and this 
country, more females than males affected with this disease have 
doubtless been treated; but, neither from this circumstance, nor from 
anything as yet adduced, can we derive satisfactory evidence of 
the male sex being less liable than the female ; for the reverse of 

I Mai. de St. Domingue, i. 4, 195. 2 Trop. Climates, 433. 
3 Fievre Jaune, 95. 4 Dis. of Seamen, 405. 

5 F. de Mauvais Caractcre, 347. 6 Mai. des Pays Chauds, 55. 

7 Typhus d'Amerique, 269, 299. 8 Tr. de la F. J. 264. 

9 Fev. of Jamaica, 250. ,0 Dis. of Army in Jamaica, 201. 

II Medica Nautica, i. 347. 12 Nouvelle Espagne, 775. 
13 Fievre Jaune, 15, 135. 14 Fievre Jaune, 218. 

is Inflam. Endem. of W. I. 13, 82. 16 Tr. de la F. J. 105. 

<* Works, iii. 80. 18 Fev. of 1793, p. 74. 

19 Physical Investigations and Deductions from Med. and Surg. Facts, 374. 

20 Fev. of 1798, p. 5. 21 Fev. of 1805, p. 78. 
22 Tr. de la F. J. 70. 23 Med. Mus. i. 33. 

21 Diss, on Y. F. of N. York in 1795, p. 2. & Tr. de la F. J. p. 73. 

as Fev. of N. Y. in 1822, p. 253. 27 Rept to B . of H. of Charleston, 7, 14. 

2s Fever of Savannah, 60. ■ Western J. i. 413. 

30 Med. Recorder, ix. 16. 31 Philad. J. of Med. and Phys. Sc. i. 10. 

32 phila. J. of Med. andPhy. Sc. ix. 246. 33 Med. Recorder, v. 61. 

34 Rap. sur la F. J. de la N. O. in 1817, p. 7. 

*5 Ibid, in 1819, p. 7. 36 Ibid, in 1839, p. 324. 

37 On Fevers, 457. 

38 Breva Descripcion de la Fiebre Amarilla, 182, 438. 

39 Fievre J. d'Andalousie, 354. 40 On Pestilential Fever, 120. 
41 On Yellow Fever, 291. «* Typhus d'Amenque, 301. 
43 Cycl. of Pract. Med,, ii. 279. 44 Contagion de la F. J. 190. 
45 Osservazioni sulla Malattia, &c. 90. 



AUTUMNAL FEVERS. 421 

the above result "sometimes occurs. "When it does not, the greater 
amount of females affected finds a ready explanation in the excess of 
female population in some of the cities where the observation was 
made, and the greater exposure of women to the infection in the 
capacity of nurses and attendants. But, however this may be, it 
has been proved satisfactorily by the statistics of every large hospi- 
tal, and by the bills of mortality of some cities where a proper 
registration is kept, that as large a percentage of male as of female 
patients die of the disease. 1 

The following are the proportions which occurred in the epidemic 
at Gibraltar in 1828, among the civilians: — 

Men . . . .684 

Women .... 286 

Children .... 200 

Difference of susceptibility of the two diseases at different periods of 
life. — Experience has shown that, with the exception of a few epi- 
demics in which children appear to have suffered severely from 
autumnal and periodic fevers, these diseases are the attendants of 
adult age — the young and very old being comparatively little ame- 
nable to the influence of the poison, and, when attacked, having the 
disease in a milder form. Exceptions to this rule are to be found 
in those seasons when the infectious effluvia are concentrated, and 
unusually powerful; or when exposure to their influence is un- 
usually great. As was mentioned in speaking of the comparative 
liability of the sexes, this ordinary exemption of the young and old 
may, in some measure, be accounted for by their less exposure to 
the action of the efficient cause. Nevertheless, a review of all the 
facts we possess on the subject, can leave no doubt on the mind as 
to a greater liability to infection in adults and individuals in the 
prime of life, than at any other period, as well as to the fact, that if 
during the course of some epidemics, or at the close of others, a 
larger proportion of children suffer, the result, on the one hand, 
must be ascribed to the fact that the adult portion of those exposed 
are acclimatized 2 — an advantage which children do not enjoy; and, 
on the other hand (as illustrated at Barcelona in 1821), to the cir- 

1 See Davidson on the Cause of Fever, 60, 61 ; Bartlett, 101. 

2 Catel, 10; Byam in Chisholm, i. 143; Arnold, 147; Statistics of British Army, 
52; Ramsay, Hist, of S. C. ii. 85; Dickson, riiil. J. iii. 257; lb. Eclectic J. iv. 112; 
Simons, 11. 



422 PNEUMONIA AND 

cumstance, that the proportion of this class remaining unattacked 
or liable to be infected 1 was, owing to peculiar causes, greatly en- 
larged. Be this as it may, if we lay aside these apparently excep- 
tional cases, and examine the accounts of those fevers as they 
prevail in tropical and extra-tropical regions generally, we shall 
find, that though children and old people are often attacked every- 
where, they enjoy, to a very great extent, the exemption to which 
I have alluded. So it has ever proved in the West Indies, in 
Europe, and in this country, as we learn from numerous and re- 
liable authorities. 2 

In a memoir on the influence of marshes on the duration of 
human life, Yillerme', in drawing his conclusions from a very large 
number of observations collected in the paludal departments of 
France, states that the injurious influence is principally felt by 
young children. He adds: 1st. Infants under one year of age ap- 
pear, relatively to their number, to suffer less than children from 
one to four. 2d. After the age of ten, the influence of marshes is 
less injuriously felt than before. 3d. It is, or appears to be, still 
less felt from fifteen and eighteen, to twenty-five; but, from thirty- 
five or forty to fifty or fifty-five, this injurious influence is more 
striking, though not as great as among young children. 4th. Fi- 
nally, old people appear more able to resist the effects of the mor- 
bific influence in question, than individuals at any other periods of 
life. 3 

This, so far as concerns children, is somewhat at variance with 
what was said above; but it should be borne in mind that the 
amount of mortality among these is not to be understood as result- 
ing from marsh fevers alone ; but evidently includes that of children 

1 Copland, iii. 168. 

2 Chisholm, i. 141; Pugnet, 348; Savaresi, 264, 265; Caillot, 15, 136; Moseley, 
438; Bally, 269-296; H. McLean, 36; Manson, 6; Madrid, 32; Dariste, 218; Ar- 
nold, 34; Rochoux, 120; Pinkard, ii. 476; Hume, 238; Williams, 51; Dickinson, 
13; Blair, 50; J. Clarke, 2; Arejula, 182; Sir James Fellowes, 58, 420; Ch. 
Maclean, 15; Berthe, 170; Mem. of Acad, of Barcelona, 23, 44; Caisergue, 191; 
Louis, 260; Burnett, 493; Pariset, 454; Palloni, 9, 10; Cleghorn, 106, Rush's ed. ; 
Deveze, 106 ; Caldwell, 78 ; Carey, 74 ; Condie and Folwell, 5 ; Monges, Matthieu, 
Rousseau (see Rept. of French Acad. 28) ; Valentin, 90 ; Thomas, 73-77 ; Harrison, 
136; Barton, 20; Gros, 71; Cartwright, ix. 16; Merrill, 9, 246; Simons, 7, 8, 10; 
Townsend, 253 ; Shecut, 109 ; A. Hosack, 9 ; Waring, 60; Dickson, Eccl. J. iv. 112; 
N. O. Fever of 1820, p. 7 ; ib. 1839, p. 325 ; Archer, v. Rec. 61 ; Brown, 88 ; Bartlett, 
344 ; Perry, N. O. J. April, 1844 ; Wharton, Am. J. July, 1843. 

3 Annales d'Hygiene. xi. 345, 346. 



AUTUMNAL FEVERS. 423 

who die from all diseases. 2d. That in all situations, whether marshy 
or otherwise, the mortality between one and five, is much greater 
than at all other periods of life. If these circumstances are taken 
into consideration, it will be perceived that the conclusions arrived 
at by Yillerme may be correct, without invalidating the statement 
made as to the greater susceptibility of adults to malarial fevers. 
It is to be remarked, also, that Yillerme' refers to the epidemic of 
Groningen in 1826. On this occasion, however, the mortality 
among children from one to five, though considerable, and large in 
proportion to that at some other periods of life, was smaller than 
among adults from forty to fifty, and from sixty to sixty-five. At 
Pantin, and other villages situate along the course of the canal of 
Ourcq, malarial fevers prevailed extensively in 1810, 1811, 1812, 
and 1813 — at the period of the construction of that canal; — but 
children do not appear to have suffered more severely than others 
(352). 

Typhoid fever may also be said to be a disease of adult age ; for 
though children, and young ones too, as well as old people, are 
sometimes attacked, they are so comparatively seldom; the fever 
bearing with greater force on individuals from eighteen to thirty. 1 

When, with these facts before us, we inquire how matters stand 
in relation to pneumonia, we discover, contrary to the stated opin- 
ions of Hippocrates, and, long after him, of Morgagni, Cullen, and 
others, that, so far from sparing children, the disease is of very 
common occurrence among them. 2 The researches of our country- 
man, Dr. Gerhard, 3 of Dr. Eufz, 4 and other modern pathologists, have, 
it is true, led to the conclusion that primitive pneumonia seldom or 
never attacks children between the ages of two to five ; but grant- 
ing this to be confirmed by subsequent and equally accurate ob- 
servation, which, seeing the result obtained by Barthez and Eilliet, 5 
we cannot for the present be inclined to do, it is admitted that they 
are very liable to the secondary form of the disease. At every 

• Chomel; Bartlett, 100; Cowan, Vital Statistics of Glasgow, 20; Geary, Dublin 
Journ. of Med. Sci. xii. 98, 99. 

2 Laennec, i. 547 ; Billard, Mai. des Nouv. nes, 1833 ; Valleix, ii. 256 ; Barthez and 
Rilliet, Essai, 77; Guersent, Diet, de Med. viii. 76; Chomel, same work, xxt. 160; 
Williams's Cyclopedia, iii. 406 ; Grissolle, 97, 98 ; Swett, 79. 

3 Am. Journ. Aug. and Nov. 1834. 

4 Journal des Connaissances Med. Ch. 1834, p. 101, &c. 

5 Maladies des Enfants, i. 108 ; lb. Essai, 76, 77. 



424 



PNEUMONIA AND 



other period of infancy, the two forms, whether lobulated or dif- 
fused, are frequently observed ; while, at all subsequent epochs of 
life, individuals are, in an almost equal degree, liable to both forms. * 
I am aware, that by many the disease is supposed to bear with greater 
force on individuals between the ages of twenty and thirty, a result 
apparently confirmed by comparative tables drawn up in the hos- 
pitals of Paris, and more particularly by the following one of 630 
cases collected by Grisolle : — 



11 to 20 years 






84 


20 " 30 " 






190 


30 " 40 " 






117 


40 " 50 " 






. 107 


50 " 60 " . 






84 


60 " 70 " 






. 37 


70 and above 






. 11 



630 1 

But when it is borne in mind that the proportion of individuals 
between twenty and thirty is considerably larger than that of any 
other portion of the population of the place where the above results 
were obtained, and that persons of that age are usually more ex- 
posed than others to the exciting causes of the disease, we shall 
cease to be influenced in our conclusions respecting the periods of 
life most obnoxious to pneumonia, by the large number of cases 
there reported. Indeed, if we take this into account, we shall find 
that the excess of frequency at that age does not reach beyond one- 
tenth, and that the same may be said of the proportion between 
thirty and fifty. The number in old age, compared with the 
number of persons who have reached that period, is very large, 
and justifies the remark of Chomel, that pneumonia, far from being 
rare in old people, is the most frequent disease to which they are 
liable, and withal the most fatal. 2 Dr. Williams remarks that, 
from his own observations, he is inclined to consider young chil- 
dren as more frequently the subject of pneumonia than adults. Of 
fifty -five cases attended by Dr. By am and himself at a dispensary 



1 Chomel, Diet, de Med. xxv. 160 ; Grisolle, 101 ; Pelletan, Mem. de l'Aead. de 
Med. viii. 335. 

2 Op. cit. 161 ; see also Grisolle, 101 ; Valleix, ii. 257 ; Prus, Mem. de l'Aead. viii. 
13 ; Hourman and Dechambre, Archives, August, 1835. 



AUTUMNAL FEVEKS. 425 

in the parish of St. Marylebone, thirty-two cases were of the age of 
six years and under. 1 A still higher authority, Laennec, 2 is of 
opinion that the two extremes of life are the most exposed to the 
influence of the disease. Dr. Swett, a distinguished physician of 
this country, recognizes the greater frequency and fatality of pneu- 
monia in infancy and old age ; 3 and epidemic pneumonia has been 
found from the days of Sydenham to our own, to be rife and highly 
fatal among persons advanced in life. 

Effects of the passions and emotions in the two diseases. — Nicholas 
Massa, very many years ago, said : u Multi ex solo timore et imagi- 
natione inciderunt in febrem pestilentialem ;" Pigray denominates 
panic " pabulum et nutrimentum pestis." Similar views have been 
entertained respecting the injurious effects of that and other de- 
pressing passions and emotions — anxiety, grief, and sorrow, as well 
of anger, and other exciting ones — as productive causes of Oriental 
plague, by Diemerbroeck, Chicoyneau, Eivirius, Hodges, Desgenettes, 
Larrey, Clot-Bey, and almost every writer on that disease. Equally 
explicit on the subject are Hoffman, Aretius, Coelius Aurelianus, 
Fazio, Chirac, Senac, Falconer, Crogan, Home, Cullen, and Huxham, 
so far as regards pestilential, typhus, nervous, or petechial fevers. In 
our own days, Dr. E. Hamilton, of Edinburgh, has shown the influ- 
ence of panic in propagating contagious fever, as exhibited in the 
Magdalen Asylum of that city, in the spring of 1821. 4 

Lind, who, like Vandermeer and others, had pointed out the 
baneful effects of mental depressions in the production of scurvy 
and other camp and ship diseases, and the benefit arising from 
cheerful and buoyant spirits, remarks, in respect to their influence 
in the production of autumnal fever, that it is quicker and more 
violent in hot and insalubrious situations, than in purer and cooler 
air. A fit of passion, he affirms, often brings on an instantaneous 
attack of fever ; a violent fit of anger or grief will immediately pro- 
duce a jaundice or the yellow fever; the sight of a corpse, or any 
object of horror, and even a shocking story told to a person, have 
been often known, through an impression of fear upon the mind, to 
bring on a delirium, sometimes a violent vomiting and purging, 
which vomit carried off the patient in twenty-four hours. In an- 

1 Cyclop, of Pract. Med. iii. 406. * Traite de 1' Auscultation, i. 547, 548. 

3 Lect, on Dis. of the Lungs, 79. 4 Med.-Chirur. Trans, of Edinb. i. 296. 



426 PNEUMONIA AND 

other work the same author reiterates the sentiment, remarking 
that it is a received opinion that fear is a canse of itself sufficient 
to produce, in certain dispositions, a bad or malignant fever ; there 
being many instances in besieged towns, where no other reason 
could well be assigned for the rise of malignant disorders, than the 
dejection of spirits, grief, and panic of the inhabitants, occasioned 
by the bombardment, and the apprehensions of a violent death 
from some sudden assault of the enemy. 1 

I am not prepared to say from personal observation, nor have I 
now the leisure to examine, how far the opinion of Lind as to the 
great injury arising from the action of the passions, under the cir- 
cumstances mentioned, exclusive of some other agency, may be 
founded. Especially am I not prepared to admit on so equivocal 
an authority as Lassis 2 — who, not content with discarding all idea 
of contagion, disbelieves the existence of infection also — that nine- 
tenths of the mortality attributed to yellow and other fevers, should 
be ascribed to the effects of the fear and panic under which every 
one labours to a greater or less extent in times of epidemics. But 
there can be no doubt that such affections of the mind, as also most 
others to which we are liable, will be found to play an important 
part in the production and aggravation of the diseases of hot cli- 
mates, and of the summer season of temperate ones, whether in 
Hindostan, in Africa, in the West Indies, in this country, in Europe, 
or anywhere else. Upon this subject there can be no mistake. 
Facts and statements in relation to it will be found recorded in 
almost every publication extant on those diseases. In his account 
of the fever of Barbadoes, in 1817, Dr. Kalph mentions, in illustra- 
tion of the influence of anxiety of mind in the development of the 
fever, the tendency it showed to affect different classes of persons. 
"First among the people of the huts it prevailed; then in the bar- 
racks. After we had lost one officer by fever, several others soon 
became affected ; and, in like manner, when one of the hospital 
attendants had died, others soon fell sick, grew alarmed, and died." 
" Un caractere ferme," is, he remarks, the best preservative from 
fevers on all occasions. To this cause we may attribute, in some 
measure, the terrible mortality of the fever in Spain, " when fear, 

1 Op. cit. 149. 

2 Causes des Maladies Epidemiques, 88 ; ib. Calamites resultant du Systeme de la 
Contagion, 9, &c. 



AUTUMNAL FEVERS. 427 

the handmaid of ignorance, reigns triumphant over the minds of 
the people." 1 

Similar statements are contained in the works of Warren, 20, 
25; Desportes, i. 24, 96, ii. 264; Clarke, Bis. of Long Toy. i. 165; 
Hillary, 146 ; Hunter, 18 ; Lempriere, ii. 10, 11 ; Chisholm, ii. 53 ; 
Pugnet, 335 ; Amiel, Johnson on Trop. CI. 270, 271 ; Chirac, Mai. Pest. 
i. 186 ; Berthe, 147 ; Pariset, 586 ; Push, iii. 49 ; Currie, 10 ; Gros, 7, 
8 ; Moultrie, 26 ; Deveze, 113 ; Johnson, Trop. CI. 74; Maillot, 265 ; 
and of others, reference to some of whom will be found at the bottom 
of the page. 2 The same remarks are applicable to excess in eating, 
drinking, indulgence in the venereal act, exposure to the sun, &c, 
all of which are known, in times of epidemics, to be. fruitful sources 
of sickness, and to bring on an attack in individuals who have been 
exposed to the action of malarial or other zymotic poisons. Were 
I, says Dr. Rush, to enter a city, and meet its inhabitants, under 
the first impressions of terror and distress from its appearance, my 
advice to them would be beware, not of contagion, for the yellow 
fever of our country is not contagious, nor of putrid exhalations, 
where the duties of humanity and consanguinity require your 
attendance, but beivare of exciting causes? 

While such is the case with malarial fevers of various grades 
and forms, it may be doubted whether anything of the kind can be 
pointed out in regard to pneumonia. There are no cases on record, 
so far as I have been able to ascertain, calculated to show that the 
disease has been brought on effectually by the depressing or ex- 
citing passions, as we have just seen in regard to fevers ; and it 
may be presumed that the medical writer who should, nowadays, 
venture on the assertion, that a large number of patients had been 
seized with the disease in consequence of their fearing to be so, of 
their labouring under the depressing effect of panic, or of their 
experiencing a fit of anger; and that others, endowed with a greater 

1 Med.-Chir. Trans, of Edinburgh, ii. 23, 24. 

2 Caillot, 138; Savaresi, 228; Gillespie, 132; Rochoux, 24, 114; Rouppe, 293, 296; 
Bally, 366; Catel, 17, 18; Rufz, 34; Osgood, 22; Dariste, iv. 23, 39, 63, 64; Lefort, 
30, 31; R. Jackson, Outlines, 249; Gilbert, 71; Bancroft, 185; Ralph, ii. 63, 64, 77; 
Mouille\ 16; Repey, 16; Lorrein, 9; Mabit, 15; Hume, 236; Copland, ii. 10, 53; 
Blin, 21 ; Audouard, 435 ; McWilliams, 105 ; Archer, Med. Recorder, v. 66 ; Drysdale, 
Med. Mus. i. 34; Tooley, 16; Barton, 20; Perlee, Chapman's Journ. i. ii. 10; Barn- 
well, 373 ; Fever of Mobile in 1819, in Jenning's collection relative to the fever of 
Baltimore. 

3 On the means of preventing, &c. autumnal diseases, Works, iv. 126. 



428 PNEUMONIA AND 

share of moral courage, equanimity of temper, or a fine flow of 
spirits, had escaped, would be likely to excite the surprise of his 
professional readers. Nor is it less evident, that, common as pneu- 
monia is in certain regions and seasons, of all countries, our own 
included, the number of cases would be vastly increased, were 
indulgences in good eating and hard drinking, and especially in 
what good old Floyer quaintly denominated " womanizing," as cer- 
tain to bring on an attack of that disease, as they are to occasion 
the development of fevers in persons exposed to a malarial atmo- 
sphere. 

It is possible that as regards the importance attached by me to 
the preceding points, as also to many of those noticed on former 
occasions, I may err ; and that for advocating them so earnestly, I 
may, in the opinion of some learned writers, exhibit myself in the 
light of one who has remained sadly behind the times. But, if I am 
really found amenable to so grave a charge, I have the consolation 
to know, that those who entertain contrary views, and may accuse 
me of ignorance, have not as yet produced anything on the subject 
calculated to establish the correctness of their own position, and 
likely to change the current of opinion on the question at issue 
among the enlightened and reflective portion of medical inquirers. 
Let the reader examine what has been written on the subject ; let 
him inquire what are the sentiments entertained on these various 
points, in this country and Europe, and he will find in what I have 
said little more than the reassertion of opinions more than once 
advocated ; and of facts and statements adduced by the very highest 
professional authorities. If I err, therefore, I do so in good com- 
pany. And surely, under these circumstances, I can have no objec- 
tion to being accused of upholding antiquated notions, of hazarding 
nothing but bare assumptions, and amusing myself with starting 
conjectures at variance with what is fancied to be the present state 
of knowledge ; provided, not that my opponents should prove that 
they are right and I am wrong, for this might give them some 
trouble ; but that the aforesaid authorities, to whom the medical 
world has heretofore found good reason to look up to as safe 
guides, should be regarded as open to the same sort of censure. 

The prevalence of the two diseases at the same time and in rapid succes- 
sion no proof of identity. — We have seen that those who advocate the 
idea of the unity of pneumonia with periodic fever, derive an argu- 



AUTUMNAL FEVEKS. 429 

ment in favour of their views from the circumstance that these 
diseases sometimes, or indeed, often prevail at the same time in the 
same place, or in neighbouring localities, or that they succeed to one 
another in the same situation, merging into each other as time pro- 
gresses. If, as it is argued, intermittent, remittent, and other fevers, 
arising indubitably from the action of malarial exhalations, and if, as 
every pathologist acknowledges, these fevers are identical in nature 
— different forms of one a ad the same complaint — if they prevail 
together, or replace each other as the season advances ; and, if from 
this circumstance of coexistence and succession we are justified in 
inferring the existence of a similarity of origin and of nature, so 
the coexistence of pneumonia with those fevers, and the succession 
of the former to the latter, must equally warrant the conclusion 
that they arise from the same cause, and constitute different forms 
of the same disease; " the difference in their characters — phenomenal 
and anatomical — arising in part from the season of the year in 
which they appear, the peculiar localities in which they occur, but 
mainly from the nature of the organs which become involved in 
the diseased action, the predominance of inflammation or conges- 
tion, and the character of their periodicity." Dr. Merrill, who seems 
to attach much importance to the circumstance of succession, and 
doubtless will not refuse to join in sentiment with those who appeal 
to that of coexistence, sums up, in a passage already cited, but 
which I must once more call attention to, the gradual changes 
which this supposed one and identical disease experiences as time 
advances. " In the spring, we are apt to find those diseases assum- 
ing names which have reference more particularly to this periodi- 
city and general pathology. As summer comes on, the greater 
implication of the hepatic organs changes the name, or adds an 
epithet to designate a prominent symptom. In autumn, the chylo- 
poietic viscera become more strikingly involved in the diseased 
action ; and this, again, is indicated by an ever-changing nomen- 
clature. But when winter approaches, and the subjects are exposed 
to sudden transitions of temperature, the thoracic viscera are called 
upon to bear the burden of local disease; and then it is that the 
names pleurisy, pneumonia, pneumonia typhoides, pneumonia bi- 
liosa, pleuro-pneumonia, bilious pleurisy, lung fever, &c. become 
familiar sounds." 

The attempt made to prove the identity of the diseases in ques- 
tion on the ground of their coexistence and succession, differs in 



430 PNEUMONIA AND 

nothing from that made to assimilate together, both as regards 
causation and natnre, certain forms of febrile diseases, which, by 
other observers, are viewed as totally distinct from each other, and 
also by that which has not unfrequently been attempted, to deprive 
them all of an independent nosological position, and pathological in- 
dividuality, and prove them to be nothing more than so many grades 
or forms of common autumnal malarial fever. But the argument 
founded on such occurrences is not more satisfactory in the one case 
than in the other. Were it valid, we should on the same ground be 
led to the conclusion that scarlatina, measles, hooping-cough, influ- 
enza, and the like, which sometimes coexist with or succeed to each 
other, are one and all offsprings of the same parent, and necessarily 
one and the same disease. We should be compelled to .admit 
also that, inasmuch as measles or influenza are followed occa- 
sionally by angina, in some of its various forms, and often coexist 
with, and more frequently — though not universally, as maintained 
by Webster — precede autumnal or periodic fever, whether these 
present themselves in the endemic or epidemic garb, it necessa- 
rily follows that they must all be viewed as resulting from the same 
cause as such fevers, and as being mere modified forms of them — 
the difference depending, as in the case of pneumonia, upon the 
season of the year at which they make their appearance, the locali- 
ties in which they may occur, or the organs and tissues which 
become involved, &c. We every day see other coexistences and 
successions of diseases which have nothing in common with each 
other in respect to pathology and etiology ; and which are equally 
independent, on those points, of the ordinary autumnal or periodic 
fevers of the localities where they show themselves. Asiatic 
cholera, for example, must have preceded, succeeded to, and coex- 
isted with, many a prevalence of such fevers, and in 1832 it existed 
simultaneously, in New Orleans, with the yellow fever ; and yet no 
writer of note, save Dr. Merrill, Dr. Searle, and a few others, have 
ever, seriously thought of holding up cholera as a mere form of 
autumnal fever — a disease which it no more resembles in respect to 
phenomenal and anatomical characters, mode of progression, and 
laws by which it is governed, than smallpox does scarlet fever. If 
it approximates it on any point, it is in appearing with greater 
force in localities noted for containing sources of malarial infection; 
a circumstance for which it has been supposed by some physicians 
of reputation in Europe, as Boudin, Marechal, Mouchet, and others, 



AUTUMNAL FEVERS. 431 

and a, few — but very few — of equal stamp in this country, to belong 
to the category of malarial diseases. But on closer and more care- 
ful examination, we shall find reason to discard such notions, and 
to conclude that, in the case of cholera, as in that # of other zymotic 
diseases which have nothing in common with autumnal fevers 
except their toxical origin, the effluvia arising from these foul 
localities, as well as putrescent food, impure water, &c, produce 
their deleterious effects, not by furnishing the efficient cause of the 
disease, but by predisposing the system of those exposed to their 
influence, to receive the morbid impress of that cause. Typhoid 
pneumonia, which some have, with equal impropriety, converted 
into a peculiar form of periodic fever, but which, from its symp- 
toms, the season of the year at which it usually shows itself, and 
the places where it has at times reigned paramount, is evidently 
unconnected with this disease, has necessarily been found in some 
localities to succeed the latter, and may, so far as I now recollect, 
have prevailed simultaneously with it. Nevertheless, few patholo- 
gists will feel disposed, from this circumstance alone, to coincide 
with them in the views they have set forth as regards the nature 
of that complaint. All who have seen much of it, recognize it to 
proceed from a special epidemic cause, similar everywhere, and 
giving rise to phenomena which impart to it a character distinct 
from that of autumnal fevers. It requires no great stretch of 
diagnostic knowledge to perceive that it is nothing but a combi- 
nation of pneumonia and typhus or typhoid fever. It reigned in 
this country from 1807 to 1820— principally from 1812 to 1814. 
During this period, typhus or typhoid fevers occurred extensively, 
while the pneumonia was superadded in some cases only. 

Typhus, typhoid, and relapsing fevers have been found to pre- 
vail together in several cities and localities of Great Britain. In 
this country, typhus, and especially typhoid — the more common 
disease of the two on this side of the Atlantic — have not unfre- 
quently coexisted, to a certain extent at least. More often they 
have succeeded to, or supplanted the common autumnal or periodic 
fever ; and yet the soundest pathologists and most experienced and 
careful observers of the day — men whom the stiffest contemner of 
book authorities may not be ashamed to look up to with respect — 
have found ample cause to regard these two fevers, however true it 
may be they both belong to the class of zymotics, as distinct diseases ; 
while the physician who, in this nineteenth century, should argue 



432 PNEUMONIA AND 

from the fact of typhoid fever prevailing at the same time with, or 
succeeding to, or supplanting ordinary autumnal fevers ; that it is 
merely a modified form of the latter disease, thus ignoring the fact 
that the former presents distinct phenomena, and gives rise to dis- 
tinct anatomical characters; that it runs a different course; that it 
has a different duration, and appears often in places where malarial 
fevers have never shown themselves, or have ceased to appear, or 
at seasons of the year when malaria is not and cannot be evolved ; 
that it is in all probability antagonistic of the other, and is propa- 
gated in a different way — would give no enviable measure of his 
professional sagacity and knowledge. 

Admit, then, for a moment, the validity of an argument in sup- 
port of the identity of pneumonia with autumnal fevers founded on 
the coexistence of the two diseases in the same locality, or the suc- 
cession of the former to the latter, and the reverse, and we shall be 
forced, for the sake of consistency, to make other and kindred 
admissions, which, in the present state of knowledge, would appear 
rather awkward. That typhoid fever is not a mere form of common 
periodic fever, is a pathological fact, which, from what precedes, I 
take for granted every intelligent and well-informed physician 
knows full well. The typhoid is the predominant fever of a great 
portion of our Eastern States, and of many districts of France, and 
other localities where periodic fevers are not at all known or sel- 
dom encountered. Paris, London, and other cities, as we have seen, 
are not visited by intermittent and remittent fevers — while typhoid 
fever prevails there extensively. Now, if we regard the pneumonia, 
which in malarial districts occurs at the same time with or follows 
on the heels of, intermittent and remittent fever, as identical with 
them, on the ground of that coexistence or succession, there is no 
reason why we should not admit that cases of pneumonia, which 
are very common in New England, in Paris, London, and other 
places subject to typhoid fever, and which coexist with or follow 
that complaint, are due to the same cause that gave rise to the 
latter, and are mere modifications of it. The conclusion would not 
be more extraordinary in the latter than in the former case. 

But there can be no necessity to enlarge on this matter. Already, 
in the opening chapter, attention was partially called to it, and 
enough was perhaps then said to justify the inference, that nothing 
favourable to the idea of the identity of pneumonia with periodic 
fevers could be made out of the fact that the two diseases coexist, 



AUTUMNAL FEVEES. 433 

or that the former succeeds to the latter. It was there remarked 
that inflammation of the lung's prevails very extensively in places 
where remittent, intermittent, and other fevers of kindred nature 
are not observed ; that it shows itself usually at seasons of the year 
when, if the ordinary causes of fever had at any time exercised 
their influence, they have been effectually or temporarily removed ; 
that in places where periodic fevers prevail daring a certain period 
of the year, they are put a stop to, in all their varieties, by frost. 
It was shown that while fevers are thus arrested, pneumonia, which 
had coexisted with them, instead of disappearing also, continues to 
prevail as it did before the accession of frost, or even is observed to 
spread more extensively; and that as the cause of the fever had thus 
been destroyed — as proved by the entire absence of its legitimate 
effects — the cases of pneumonia which continue to show themselves 
after the accession of frost, cannot be referred to the morbid agency 
of the cause in question, but are due to the operation of some other 
morbific influence, over which frost exercises no control, and differ- 
ing consequently from the former. It was stated that the same 
causes which give rise to pneumonia after a stop has been put to 
periodic fevers by frost, must be similar to those that produce the 
disease during the prevalence of those fevers and anteriorly to the 
occurrence of frost. It was moreover argued that, if the cause 
which produces pneumonia after that event must, for reasons 
stated, differ essentially from that occasioning the fevers thus 
arrested in their course, the cause giving rise to the cases that ap- 
pear during the fever season, must also be different from the febrile 
poison; that hence, when the two diseases show themselves to- 
gether, two sets of causes are at work; that from this difference of 
cause we have reason to infer the existence of a difference in the 
nature of the diseases produced ; and that when pneumonia, in the 
regular succession of the seasons follows on periodic fevers, after the 
accession of cold or frost, or at the period of atmospheric vicissi- 
tudes, it is not influenced in its production by the cause of those 
fevers. It appears, therefore, as the effect not of a gradual change 
from one form to another of the same complaint, but as the result 
of the creation of a different, or the continuance of an independent 
disease. 

Pneumonia and autumnal fevers are not convertible diseases. — In 
order that coexistence and succession may furnish material towards 
28 



434 PNEUMONIA AND 

building an argument in favour of the identity of the two diseases, 
it is necessary that they should be combined with other concomi- 
tant circumstances. Separately considered, they can serve but little 
purpose, and lend but feeble aid in the settlement of the question. 
The connection of intermittents with remittents, which has been 
appealed to, in illustration of the supposed identity under examina- 
tion, affords but little support to the argument, because it is founded 
to a much greater extent on other and more weighty facts than 
mere coincidence and succession. Under much variety of aspect, 
as is remarked by a most eminent writer of this country, these 
fevers "possess many deep-seated analogies and identities; they fre- 
quently change from one type to the other. Thus, an intermittent 
turns into a remittent, and the latter, assuming the type of the for- 
mer, is often seen to become, first a quotidian, then a tertian, and 
finally, a quartan. A simple intermittent may, in the third or 
fourth paroxysm, take on the character of a fatal congestion; and 
that which began with an aspect of malignity, sometimes emerges 
into simplicity and mildness; vernal agues attack those who, in 
autumn, had suffered under remittent fever, not less than those who 
had experienced the intermittent form ; the sequelae of all the varie- 
ties are almost identical; the same treatment, with certain modifica- 
tions, is applicable, to the whole." Surely, nothing of this kind is 
observed to occur in reference to many diseases, the identity of 
which is insisted upon on the ground that they coexist together, 
or follow each other in the same locality. The yellow and common 
autumnal fevers, though kindred zymotic diseases, and arising from 
malarial exhalations, are not, strictly speaking, convertible, though 
cases occur which exhibit symptoms characteristic of both, and the 
diseases may either blend together, or appear in rapid succession 
in the same subject. Eemittents or intermittents never change 
into yellow fever, and vice versa ; their anatomical characters and 
sequelae are not the same; those attacked with yellow fever in the 
autumn, are not affected with ague the following spring, and the as- 
pect of the two diseases are not the same. In a word, they do not 
possess deep-seated analogies and identities similar to those existing 
between the various forms of ordinary paludal fevers. Still less 
allied to autumnal fevers in those respects, are typhoid or typhus 
fevers, and true oriental plague, which, under the fostering hands of 
some unitarian pathologists, have been admitted into the family of 

1 Drake, 704. 



AUTUMNAL FEVERS. 435 

periodic marsh miasmatic fevers, there to keep company with yellow 
fever, Asiatic cholera, typhoid pneumonia, to say nothing of phre- 
nitis, gastritis, gastro-enteritis, hepatitis, and, for what I know, peri- 
tonitis, cystitis, tonsillitis, nephritis, gout, rheumatism, and the rest 
of the forty or fifty different varieties of diseases into which, as we 
are told, the nosology of soutKern fevers might be arranged, and 
which constitute so many links in the chain of morbid action, ex- 
tending from a septenary ague up to the most violent and fatal form 
of yellow fever. At a still greater distance, in these same respects, 
from autumnal fevers, do we find pneumonia. So far as I am aware, 
the physician is yet to be found who has discovered that pneumonia 
and periodic fevers are convertible diseases in the way that the seve- 
ral forms of these have been shown to be. A case of intermittent or 
remittent is not converted into pneumonia by injudicious treatment, 
or a case of pneumonia transformed into a mild intermittent by 
proper, or into malignant remittent by improper remedies; their 
sequelae are not identical. Those who have pneumonia in the autumn 
or winter, do not run as much risk of suffering from vernal agues 
or summer remittents, as those who have passed through these com- 
plaints ; they do not possess many deep-seated analogies and iden- 
tities, and the same treatment would require more than trifling modi- 
fications to make it applicable to both. 

In saying this much on the subject, I am far from denying the 
change from one disease to another. Such changes are of daily 
occurrence, and are observed in regard to almost every complaint 
to which the human system is subject. A case commences with 
symptoms of common remittent or intermittent fever, and at its 
close exhibits phenomena appertaining to yellow fever. In other 
instances the reverse occurs, cases of yellow fever ending with 
symptoms of periodic fever. Typhus, typhoid, or pestilential fevers 
terminate sometimes in the same way ; while, at other times, cases 
which at their outset presented the characteristics of common inter- 
mittent or remittent fever, assume, as the disease progresses, those 
of the fevers mentioned. So also with regard to pneumonia and 
fever. Cases of the former not unfrequently, under peculiar ende- 
mic or epidemic influences, end with symptoms of autumnal, as also 
of yellow, or typhus, or typhoid fever. On the other hand, cases 
of periodic or other fevers sometimes terminate with symptoms of 
pneumonia. 

Doubtless changes of the kind may, strictly speaking, be re- 



436 PNEUMONIA AND AUTUMNAL FEVERS. 

garded as the effect of conversion; but the conversion herein 
noticed is not that of one form of a disease into another form of the 
same. It cannot be occasioned by an increased force in the canse 
of the disease first existing, by a difference in the state of predispo- 
sition of the person attacked, or by the peculiar mode of treatment 
pursued. It is not the result of a mere modification of one and the 
same thing ; but a change of one thing to another of a more or less 
different kind ; in a word, it is the substitution, partial or complete, 
of one disease for another. Such conversions of diseases are not of 
rare occurrence. They are, indeed, familiar to all practitioners. 
They often lead to evil or fatal consequences, or simply to the 
removal of disease without restoration to health ; and, without feel- 
ing disposed to believe, with Sir Greorge Gibbes, that one disease is 
always necessary to the cure of another, that just as many functions 
undergo a secondary derangement as are necessary for the cure of 
the primary one, and that no diseases occur but such as are curative 
in their effects or in their tendency, 1 we cannot doubt, taught as 
we are by daily experience, that the cure of one disease is often 
effected by the occurrence of another; but whether leading to 
baneful or salutary consequences, while many conversions are due 
to the transfer from one part to another of a specific cause, floating, 
as it were, in the system, as the gouty, rheumatic, &c, a large num- 
ber are the effects, not of the operation of such a cause acting in 
this latter way, but, as already stated, of the slow or abrupt substi- 
tution of one disease for another ; sometimes, though not necessarily, 
allied to it in a pathological or etiological point of view. 

The late Dr. Hillier Parry, 2 of Bath; Dr. Mackenzie, 3 and others, 
relate interesting cases of the kind, and several have fallen under 
my own observation, embracing a variety of dissimilar complaints; 
and if such occurrences are admitted to take place in the cases men- 
tioned, we can have no reason to doubt that the same will hold good 
in reference to those instances in which symptoms of one fever re- 
place those of another ; as also in those in which the phenomena of 
autumnal fever succeed to those of pneumonia, and vice versa. 

1 Brit, and For. Med. Rev. xxiii. 591. 

2 Elements of Pathology and Therapeutics, i. 48, 306-320. 

3 Sketch of the Natural Cure of Diseases, Brit, and For. Med. Rev. xxiii. 590. 



CHAPTER VII. 

PNEUMONIA AND AUTUMNAL FEVERS, ALTHOUGH INDE- 
PENDENT OF EACH OTHER, AS REGARDS NATURE AND 
CAUSE, COMBINE TOGETHER, AND FORM, LIKE OTHER 
COMPLAINTS, HYBRID DISEASES, WHICH MUST NOT BE 
CONSIDERED AS PECULIAR FORMS OF EITHER. 

Cases of pneumonia marked by symptoms appertaining to autumnal 
fever, are the results of complications. — I am prepared to be told that, 
so far, my remarks can have had reference only to pure and idiopa- 
thic pneumonia, such as the disease is said to show itself in high and 
healthy localities and northern latitudes, and that they do not apply 
to that form of it which physicians in the south or southwest are 
in the habit of observing. I may be told, that cases there present 
themselves, in which the ordinary symptoms of pneumonia are more 
or less modified, and are associated, to a greater or less extent, 
with other phenomena which approximate the disease to autumnal 
fevers ; and that while in other regions thoracic inflammation may 
be, for what we know — for on that matter doubts are occasionally 
expressed — independent of periodic fevers both in regard to causa- 
tion and nature, the cases which prevail in malarial countries, and 
exhibit the phenomena in question, may be admitted to give coun- 
tenance to the hypothesis under examination. Of the occurrence 
of such cases, no experienced or well-read physician can be igno- 
rant. He must be fully aware, that in miasmatic regions they are 
frequently encountered, and that there pneumonia — like, indeed, 
very many other diseases — often, if not generally assumes, to a 
greater or less extent, the periodic type. So frequently are such 
cases observed in those regions, and so decided often is the tendency 
to this type, that it cannot be a matter of astonishment that some 
physicians, noticing a succession of instances of the kind, and yield- 
ing too readily to a spirit of exaggeration and hasty generalization, 



438 PNEUMONIA AND 

pardonable in individuals of limited professional acquirements, but 
which ought not to be encountered in other quarters, should have 
been deceived, and arrived at the conclusion that, with few ex- 
ceptional instances, in which they admit, on the authority of others, 
the disease to be idiopathic, "the pneumonia which prevails in this 
country, sometimes sporadically, and frequently as an epidemic, is 
really and substantially nothing more than a peculiar form of 
remittent and intermittent fever." 

But when we view these facts more attentively, without being 
swayed by a favourite hypothesis, and with a full knowledge of 
the occurrence of kindred modifications in a number of other dis- 
eases, and of the diversified effects produced in many complaints 
by the various modifying influences that surround us, we shall not 
be long in perceiving, that the facts in question admit of an easy 
explanation, on principles very different from those contended for 
by the advocates of the identity in question, and in a way which 
renders unnecessary the disunion of the beforementioned class of 
pneumonias from the ordinary form of that disease. It is a fact 
well ascertained, and perfectly familiar to those who have investi- 
gated the subject of the progress and succession of epidemic or 
endemic diseases, that the type of the fever which prevails immedi- 
ately before the outbreak of pneumonia — in other words, before the 
period of the year at which the usual causes of the latter are mostly 
encountered and operate with more force and effect on constitutions 
predisposed to their action arrives — impresses its own character on 
pulmonary inflammations. Hence at that season, low surfaces, the 
vicinity of mill-ponds, of the banks of streams, and of other locali- 
ties, which before were the abodes of pure remittent and intermit- 
tent fevers, become the seat of pneumonias, which often assume a 
marked remittent, and not unfrequently an intermittent character — 
the result of anterior influences; while the same disease in other situ- 
ations where malaria is not evolved, or at a more advanced period of 
the year, when it has been completely destroyed, presents nothing of 
the kind for a longer period. 1 The same combination of phenomena 
is necessarily observed for a longer period whenever pneumonia shows 
itself in localities where malaria continues to be evolved all the year 
round, or where, from the absence of frost, it is only moderated, and 
not completely destroyed. In many such cases the inflammation of 

1 Lewis, Med. Topog. of Alabama, N. 0. J. iv. 28. 



AUTUMNAL FEVEES. 439 

the lungs presents itself in combination with symptoms appertaining 
to ordinary bilious remittent fever, or hepatic or bilious derange- 
ment, giving rise to what is denominated bilious pleurisy, a form 
of disease accurately described by many American and European 
writers. 1 In other instances, the bilious symptoms are not so pro- 
minent, and the affection of the lungs is associated with those of 
simple remittent or intermittent fevers. 2 Indeed, instances of re- 
mittent and even intermittent pneumonia, pleurisy and pulmonary 
catarrh, in which the inflammation is complicated with symptoms 
indicating the existence in greater or less purity of the element of 
periodicity, are to be found described in the writings of the most 
reliable authors. Morton, who early called attention to them, and 
indicated the treatment they required, had seen a hundred such 
cases ; and since his day they have continued to be adduced as ob- 
jects of familiar professional observation, not only in Europe, but 
in this country also. 3 

The pleurisies which prevailed in Minorca, in 1745-46, and of 
which Cleghorn has left us so graphic a description, commonly 
began like an ague fit, with shivering and shaking, flying pains all 
over the body, bilious vomiting and purging, which were soon 

1 Biancki, Hist. Hepat. i. 236; Stoll, Med. Constitution of years 1776-77, i. 50; 
Frank, pt. 2, ii. 350 ; Forsyth, Med. Eep. xii. 353 ; Williams, Med. Reg. iii. 454 ; 
Potter, Med. Recorder, iv. 404 ; Drake, i. 749, 765 ; Wood, ii. 38 ; Pelletan, Mem. 
Statist, sur la Pleuro-pn. Mem. de l'Acad. de Med. viii. 443 ; see Bulletin de l'Acad. 
i. 835 ; iv. 447 ; Eberle, Pract. of Med. i. 284. 

2 Matheson, Charleston J. iii. 152; Oliver, N. 0. J. vii. 387-89; Day, ibid. ii. 578-587. 

3 Morton, Opera Omnia Hist. &c. 21 ; Brera, Journal de Sedillot, xxxiii. ; Bailly, 
Fievres Intermittentes, 253 ; Gouzee (of Antwerp), Archives, 2d series, iv. 71 ; Da- 
niel (of Cette), Ephemerides de Montpellier, iv. 339, 357, 454; Gouraud, Etudes 
sur les Fievres Interm. 103 ; Sarcone, Mai. de Naples, i. 202 ; Frank, ii. 352 ; Mou- 
ton, An. Clin, de Montpellier, xxvii. 133 ; Laennec, i. 391, 4th ed. ; Alibert, 57 ; 
Bonnet, F. Interm. 76, 118; Detournel, Arch. Gen. April 1829, p. 255 ; Nepple, F. Int. 
99, 124, 266; Roche etBerquin, Nouv. Elem.i. 440; Leonard and Foley, Researches sur 
l'Etat du Sang, &c. en Algerie, Mem. de Med. and de Chir. Militaire, lx. 135, 209 ; De 
Renzi, Miasmi Paludosi, 121 ; Lauter, Hist. Medica Bienn. Marb. Rural, 5th and 7th 
cases; Strack, Obs. de Feb. Intermit., obs. 32, 58, p. 74; Sauvages, Nosol. Med. ii. ; 
Abloing, Journal General de Medicine, lviii. ; Matthei, Journal de la Societe Med.- 
Chir. de Parme. ii. ; Bonaldi, ib. ; Archier, Journal de Med. 1784, lxi. ; Evans, 54, 17, 
71, 78; Chauffard, Traite des Fievres, 254, 257; Maccullocb, 385; Mongellaz, 221, &c. ; 
Bibliothique Med. Jan. 1819, from Tr. of Med. Soc. of Lyons, N. A. Med. and Surg. J. 
viii. 193; Du Pre, Charleston J. v. 607, 608; Maillot, 17, 41, 127; Raymond, Mem. 
de la Soc. Roy. de Med. iv. 72 ; Foster, Stethoscope, iii. 91-93 ; Blake, N. O. J. vii. 
510, 511; Rochoux, Bulletin de l'Acad. i. 926; Cooke, Recorder, vii. 459 ; Meli, Sulle 
Febbre Biliosi, 54, 55. 



440 PNEUMONIA AND 

succeeded by quick breathing, immoderate thirst, inward heat, 
headache, and other feverish symptoms. In a few hours, the respi- 
ration became more difficult and laborious ; the most part of the 
sick being seized with stitches in their sides. In a few instances 
these complaints preceded the fever ; in others they did not come 
on till the day after. Many were drowsy, and inclinable to sleep, 
but they raved at intervals, or were much disturbed with extrava- 
gant dreams. In the mean time, the internal heat was in several 
very moderate ; in some less than natural ; but, for the most part, 
it was so intense as to raise the thermometer to the 102d degree; 
and often in the afternoon to the 104th. The pulse was likewise 
very variable, not only in different persons, but in the same at dif- 
ferent times. In some cases it was like that of a man in health, or 
even slower than natural, while the patient was in the greatest 
danger ; so that it could neither be depended upon as a prognostic 
sign, nor as an indication of cure. Nor was the colour or con- 
sistence of the blood more to be trusted ; in many it had a white 
or pale yellow crust, the serum being of the same complexion; but 
for the most part it was red and florid. Besides some abatement 
of the fever, which commonly happened every morning, it was 
remarkable that upon the third day, or beginning of the fourth, 
there was frequently a great remission, sometimes a total cessation 
of every violent symptom, so that the sick were thought to be out 
of danger ; but on the fourth or fifth, a delirium suddenly came on, 
or the breathing became more difficult than ever, and one or both of 
these symptoms increasing hourly, the patient expired in a day or 
two, either suffocated or raving mad, unless, nature or art assisting, 
he had the good fortune to escape by some critical evacuation. 1 

In the bilious pleurisy or pneumonia of many regions of our 
country, the reader will recognize a disease much resembling the pre- 
ceding, and which, unless biased by strong theoretical prepossession, 
he cannot fail to regard as the result of the combined agency of 
miasmata and atmospheric vicissitudes. The following description 
of the disease, by Dr. Eberle, embodies all that need be said on the 
subject. The initial symptoms differ very little from those which 
usually usher in an attack of ordinary remittent bilious fever. In 
some instances, a sense of fulness and tension is experienced in the 
right hypochondrium, a few days previous to the supervention of 

1 Dis. of Minorca, 261-266. 



AUTUMNAL FEVERS. 441 

the disease, and occasionally dysenteric symptoms occur before the 
fever commences. In almost all the cases considerable pain is felt 
in the back and extremities during the premonitory period. The 
skin, from the beginning, is more or less tinged with bile, and the 
conjunctiva especially is conspicuously icterode. The face is flushed, 
and a sickly mixture of red and yellow, upon close examination, 
betrays the existence of a disturbed state of the liver. Acute pain 
in the forehead is almost constantly present. The pain in the chest 
is sometimes extremely severe and pungent ; but more commonly 
it is obtuse, and attended with a sense of weight or oppression in 
the breast. In some cases the fever continues for several days 
before the pectoral pain supervenes. The expectoration is not very 
copious, the sputa being of a frothy, yellowish appearance, marked 
frequently with streaks of blood. The fever is generally attended 
with manifest evening exacerbations, and morning remissions. 
When vomiting takes place, an occurrence very common in this 
affection, more or less of bilious matter is generally thrown up, 
although in some instances the secretion of bile appears to be en- 
tirely suspended; the ejections consisting of nothing else than 
gastric mucus and the ingesta. The tongue is at first white, with 
a yellowish streak along the middle, which, as the disease advances, 
becomes dark brown and dry. The urine is always of a deep yel- 
low or bilious colour ; and the pulse is generally small, frequent, 
and quick, with a slight degree of preternatural tension. 1 

In the following statement we certainly do not recognize the 
phenomena of the ordinary and legitimate form of pneumonia, or 
pleuro-pneumonia, and must, as in the preceding, admit the admix- 
ture of some of the characteristics of malarial fevers. The vicinity of 
marshes within the tropics, and in countries, during the summer and 
autumn, subject to tropical heat, says Chisholm, is always influential 
in the formation of the type and character of the disease. This is re- 
markably exemplified in dysentery and pneumonia. In the latter it 
" gives the disease, originating in suspension or interruption of the 
functions of the cutaneous organization, a remittent or intermittent 
form. In fevers of an infectious nature, whether symptomatic or 
idiopathic, the same type is communicated by the reception of the 
marsh miasmata into the system, without suspending or changing 
the original diathesis. Thus smallpox, measles, and scarlatina have, 

1 Treatise on the Practice of Medicine, i. 284. 



442 PNEUMONIA AND 

in such situations, a remittent, or even an intermittent form of 
symptomatic fever ; and thus, from the same cause, idiopathic in- 
fectious fever has often superadded the type. All these, therefore, 
under such circumstances of locality, are truly hybrid diseases; 
although, in their treatment, the original disease is alone to be re- 
garded. In hybrid pneumonia, the pneumonic symptoms and fever 
are concomitant, and affect the patient according to the type of the 
latter ; in paroxysms, if it is intermittent ; in remissions and exacer- 
bations, if it is remittent; that is, the pneumonic symptoms are 
always exasperated during the presence of the fever, and mitigated 
during its intermission or remission." 1 

As we have seen in the opening chapter of this volume, Dr. 
Vaughan, of Delaware, founded his opinion regarding the identity — 
pathological and etiological — of pneumonia and fever, partly on the 
occurrence of cases of the former in which the pulse presented 
peculiar characters, the fever had a tendency to assume a tertian 
type, and the countenance became early hippocratic. 2 "We have 
seen also that Dr. Forry inclined to the same opinion, because 
sundry cases reported by Drs. Pitcher and Wharton, of the army, 
partook of the intermittent character, and were successfully treated 
by the same remedies which are found to arrest intermittent fevers. 3 
A farther proof of the existence of such cases will be obtained by 
referring to the great work of Dr. Drake, as well as to an essay by 
Dr. Boling, of Montgomery, Ala., in which the blending of the peri- 
odic type with pulmonary and other inflammations, is ably treated 
and amply illustrated by interesting cases. 4 

Within the last few years, as we learn from the Charleston Medical 
Journal, even thoracic diseases — bronchitis, pneumonitis, pleuritis, 
&c. (while retaining their distinctive characters), have taken on a 
strongly-marked periodical — intermittent or remittent — character. 
Two years ago, in Charleston, almost all the cases of the above- 
mentioned diseases were of this nature, and were promptly checked 
by quinia. 5 Nor is it in the south alone that such a tendency has 
been noticed. Dr. Bush, in his account of the bilious fever which 
prevailed in Philadelphia in 1780, states that in the spring of that 
year, a catarrh appeared among children, from one to seven years 
of age. " It was accompanied by a defluxion from the eyes and 

1 Manual of the Climate and Diseases of Tropical Countries, 106. 

2 Med. Repos. iv. 130. 3 Climate of the U. S. 186. 
4 Am. J. of Med. Sc. viii. 87, and N. S. 5 Vol. v. 824. 



AUTUMNAL FEVERS. 443 

nose, and by a cough and dyspnoea, resembling in some instances 
the cynanche trachealis, and in others a peripneumony. In some 
cases it was complicated with the symptoms of a bilious remittent 
and intermittent fever. The exacerbations of this fever were always 
attended with dyspnoea and cough." 1 Among the sick labouring 
under the fever they had brought to England from Walcheren, or 
who were attacked after their return from the latter place, pneu- 
monia was of common occurrence, especially about the month of 
November, when they were exposed to the combined influence of 
cold and humidity. In such cases the pulmonary influence was 
modified in its type and other peculiarities by the paludal fever 
with which it was associated. 2 

Sir George Baker, in his description of the influenza of 1762, 
states that the disease exhibited the intermittent character. " Some- 
times it proved periodical, and of the tertian type." 3 Dr. Holland 
made the same observation in London, during the epidemics of 
that disease which prevailed there, from 1831 to 1838, remarking 
that the tendency to intermittent symptoms, both tertian and quo- 
tidian in type, and often very regular in period, seemed to be more 
common when the disorder was abating. 4 A similar fact was no- 
ticed by Dr. Kush, who, in his history of the influenza of 1807, 
observes : " The bilious fever which prevailed in August imparted 
to it several of its symptoms. There were obvious remissions and 
intermissions, great pain in the back, and apparent cessation of the 
symptoms of the disease on the third, and a return of them on the 
fourth day, &c. The disease appeared in one respect to be a mon- 
ster ; its head and breast wore the character of influenza, while its 
trunk and limbs indicated it to be a bilious fever." 5 

Pneumonia and other inflammations presented the periodic ele- 
ment, and other phenomena appertaining to malarial fevers, during an 
epidemic of the latter which prevailed at Auch (France) a few years 
ago, a description of which was given by an able physician of the 
place, M. Campardon. 6 Dr. Constant, who practises in one of the 
marshy districts of the Department of the Lot in France, has seen 

1 Works, ii. 231. 

2 Davis, Scientific and Popular View of the Fever of Walcheren, 10-42. 

3 Treatise, &c. in Collection of the Sydenham Soc. 73. 

4 Medical Notes — Connection of Certain Diseases, 64. Am. Ed. 

5 Vol. iv. 101. 

6 Bulletin de l'Acad. de Med. viii. 634. 



444: PNEUMONIA AND 

much of that form of disease, and draws attention to the signs which 
distinguish it. The initial shivering is more intense and prolonged 
than in ordinary pneumonia ; the local pain is felt early, and always 
in front of the chest, although the congestion is localized posteriorly ; 
it is more amenable to blisters than to leeches ; violent headache 
comes on early, and is either frontal or sincipital ; there is often severe 
lumbar pain, which observes the same stages of increase and de- 
crease as the headache ; the shivering is followed by intense heat, 
which, after several hours, gives place to abundant sweating ; the 
pulse, during the paroxysm, in place of being full, strong, and 
vibrating, as in ordinary pneumonia, is rapid, soft, undulating, and 
compressible; there is never any purulent expectoration, these 
pneumonias never proceeding beyond the second stage, i. e. red 
hepatization, the pulmonary engorgement being rather a sangui- 
neous congestion than inflammation; auscultation shows the rapid 
passage from the first to the second stage ; for eight or twelve hours 
will be sufficient for the passage from a circumscribed rale to the 
hepatization of a whole side. The disease especially appears in 
summer and autumn, while ordinary pneumonia prevails in spring 
and winter. The blood from a vein is often below the normal tem- 
perature, very black, and deficient in plasticity. After rest, its 
surface acquires a bluish colour, especially if the patient is taking 
quinia. The clot is slow in forming, and soft. The buffy coat is 
absent, or very thin, and inclines to a bluish colour. In the dis- 
trict where the form of pneumonia here described is seen, purely 
inflammatory pneumonia is observed during winter ; but, in propor- 
tion to the high temperature and the production of malarial emana- 
tion, this inflammatory element is replaced by the paludal one. 1 

In the foregoing instances we certainly have pulmonary inflam- 
mation ; but the form which the disease assumes differs somewhat 
from that we see elsewhere. It is peculiar in its type, in the greater 
length and distinctness of its remissions, and in the gastric and bilious 
symptoms by which it is accompanied; as well as in the condition 
of the blood, pulse, skin, and expectoration. Everything, indeed, 
affords proof of the existence of a periodic or malarial element. 

1 British and For. Med.-Chir. Rev. xii. 552, from the Bulletin de Therapeutique, 
xliii. 481-491. 

The same complication is noticed on a large scale, both as regards pneumonia and 
pleurisy, in Rio Janeiro and other parts of Brazil, where, as we learn from Sigaud, who 
mentions the fact, the periodic or malarial element associates itself to all diseases. 
See his excellent work on the climate and diseases of that country, pp. 301-304. 



AUTUMHAL FEVERS. 445 

Though sometimes encountered in ordinary fever seasons, and in 
anost places subject to malarial fevers, and though more particu- 
larly rife in times of violent and wide-spreading epidemics, and in 
very sickly localities ; this complication of inflammation of the lungs 
with miasmatic fever is not unfrequently found to occur under 
circumstances of a different kind ; for, by virtue of the power of 
latency possessed by these, the system remains predisposed to 
them ; and the same exciting cause which occasions an attack of 
pneumonia, long after or in a healthy season, calls into activity 
the malarial poison, and the result is the compound disease under 
consideration. This condition of things has been observed in all 
miasmatic countries, and nowhere more strikingly than in our own. 
By more than one of our southern physicians who have not adopted 
the views at present under examination, we shall be told, that, as 
many carry the predisposition to miasmatic diseases throughout the 
autumn without having fever excited, so some continue to retain 
it in the winter, and on some sudden exposure to cold, which often 
produces it in the autumn, fever is excited in those who continue 
in that state; or if the approach of cold weather be sudden and ex- 
cessive, before the predisposition is done away, and proper provi- 
sion made against the weather, the number affected is greater. In 
the winter following those seasons in which miasmata abound, the 
number of persons remaining predisposed, and the predisposition 
itself, are greater. Sudden cold, then, produces many cases of com- 
bined symptoms of summer and winter disease. 1 

But neither in these instances, numerous and interesting as they 
doubtless are, nor in those cases of remittent or intermittent perito- 
nitis, rheumatism, ophthalmia, apoplexy, hemiplegia, convulsions, 
meningitis, lunacy, of which we read in the writings of Torti, 
Morton, Morgagni, Elliotson, Macculloch, Mongellaz, Gouraud, 
Laycock, Boling, 2 and examples of some of which I have myself 
not seldom observed in this country and Europe, can we dis- 
cover any good reason for creating a new class of diseases, distinct 
from the ordinary inflammation, congestion, or irritation of the 
parts affected, both as regard cause and nature. Still less are 
we justified in admitting the identity of the two diseases repre- 
sented in the compound of phenomena noticed, or that the one 

1 Cooke, Med. Recorder, vii. 460. 

2 See also Med.-Chir. Trans, iii. 348; Med. Gaz. iv. 116; Med.-Chir. Rev. xiv. 514; 
London Lancet, i. 425. 



446 PNEUMONIA AND 

is a modification, or really and substantially nothing more than a 
peculiar form of the other. To me, as also to some of the writers* 
just referred to, and to many more I might cite, all these cases fur- 
nish illustrations of the complication or coexistence of two distinct 
complaints, produced by distinct causes, having distinct seats and 
characters, and being governed by different laws, but which often 
modify each other to a greater or less extent. 

Similar views were long entertained by high professional authori- 
ties. In an excellent essay on the " relation existing between epi- 
demic and other diseases prevailing at the same time and place, 
and denominated intercurrent," 1 Eaymond, among others, in refer- 
ence to facts he had observed during a long series of years, dwelled 
at some length on the complication of pneumonia with the epidemic 
or stationary constitution of the atmosphere existing at the time the 
disease happens to show itself, and remarked: "Those kinds of 
thoracic inflammations have constantly assumed the types of the 
epidemic constitution during the existence of which they appeared. 
They have engrafted themselves on the epidemic or constitution of 
the year, and presented the same symptoms and the same functional 
lesions, in addition to the affection of the respiratory organs which 
characterizes them in a special manner. Apart from the expectora- 
tion, which appertains to them, their march, their critical movements, 
and their mode of termination, were the same. Inflammation of 
the lungs is, therefore, composed of, or complicated with, the sta- 
tionary modes or symptoms of the constitution or epidemic of the 
year, and of the transient and intercurrent constitutions of the period 
and of the seasons from which they arise." If, he continues, inter- 
current diseases are founded on constitutional fevers, in their turn 
intermittent fevers are often complicated with the elements by which 
the former are characterized. 

While the "Walcheren fever which pursued the British troops to 
England, or attacked them after their return home, was the off- 
spring of a morbid agent which had impressed the system in a 
distant land; the pneumonia with which, as we have seen it was 
often combined, was the effect of a cause appertaining to the place 
where the complaint showed itself. The combination thus pro- 
duced must consequently be regarded as the result of the action of 
two seperate sets of causes, and hence as a compound of two inde- 

» Mem. de la Soc. Roy. de Med. iv. 72, 73. 



AUTUMNAL FEVEES. 447 

pendent diseases. Dr. Davis, who calls attention to the occurrence 
in question, evidently takes this view of the subject. After remark- 
ing, that all the important consequences entailed by protracted 
intermittent, comprehended enlargement of the liver and spleen, 
wasting of the omentum, inflammation of the peritoneal cavity of 
viscera, extensive adhesions of the abdominal viscera to each other, 
scirrhosity of the pancreas, enlargement of the mesenteric glands, 
chronic inflammation of the intestines, dropsy, jaundice, &c. he 
adds : " The chief disorders combined with intermittent were pneu- 
monia and angina. I have known pneumonia to. be repeatedly 
combined with simple and double tertian paroxysms; and in Chap- 
man's Medical Commentaries, there is a corroboration of pulmonary 
complaints assuming an intermittent type. Though it is a fact that 
autumnal intermittents are apt to run into dysentery, and vernal 
intermittents to attack the lungs, yet one of the most frequent com- 
binations of the protracted fever of Walcheren was inflammation 
of the lungs, an affection that became very frequent in November, 
and that generally ended fatally." Section 8 of Dr. Davis's work 
is headed, " Pneumonia as a combination with the primary disease." 
He therein describes a peculiar form of the complaint, to which the 
fever patients were particularly subject, and adds: "Pneumonia 
never was symptomatic of the Walcheren remittent, as it sometimes 
is of measles, catarrh, and phthisis pulmonalis ; but was combined 
and interwoven in a particular manner with it, so as apparently to 
constitute a part of the stime disease." 1 

The true nature of these cases did not escape the sagacity of our 
great medical philosopher, Dr. Drake. "The lungs, it is well 
known," as he remarks, " are liable to inflammation in this fever ; 
and, instead of occurring late in the disease, like cerebritis, it gene- 
rally arises at an early period. Such inflammation may prove 
fatal ; and then a post-mortem inspection will show the lesions result- 
ing from bronchitis or pleurisy, but more frequently still those of 
pneumonia, such as sanguineous engorgements and hepatization. 
But they cannot be regarded as constant, essential, or characteristic 
of autumnal fever; for, first, a vast majority of cases, even those 
which prove fatal, do not present a single symptom of pulmonary 
inflammation; and, second, this inflammation, in most instances, is 
the undoubted effect of sudden changes of weather in the latter part 

» Op. cit. 42, 149, 153. 



448 PNEUMONIA AND 

of autumn, and must, therefore, be taken as the offspring of an 
incidental cause, acting subsequently to that which produced the 
fever." (824.) In another place, Dr. Drake states that the most 
frequent of the complications occasioned by the influence of malarial 
fevers is that presented by the pneumonias of the south, and also 
of the lakes in the north (765). 

Again, in speaking of the complications of intermittent with other 
diseases, the same eminent writer farther says : " But the more fre- 
quent and formidable of these complications is that presented by the 
pneumonias of the south, as also on the shores of the lakes in the 
north, where numerous cases occur, which the profession too often 
find unmanageable by any method of treatment they have been 
able to devise." (i. 765.) In another place, he calls attention to the 
fact that the subdiaphragmatic viscera, except the pancreas, are 
subject to inflammation in remittent fever, and says : " Sometimes, 
however, from idiosyncrasy, or the co-operating action of other 
causes, inflammation in other parts occurs," " and, when the fever 
makes its attack late in autumn, the combined action of vicissi- 
tudes of temperature, and that of the specific cause, developed at 
an earlier period, may determine inflammation upon the lungs or 
pleura." (740.) " The pneumonia biliosa," says Dr. Potter, " is a 
compound affection, originating from a double remote cause." " It 
is the immediate offspring of a low temperature, engendered upon 
a miasmatic predisposition." (Op. cit.) 

Dr. Eberle is decided in the opinion that this variety of pneu- 
monia, which occurs during cold and variable seasons, abounding 
in sources of miasmatic exhalations, is the result of the combined 
agency of koino-miasmata, and atmospheric vicissitudes. (Op. cit. i. 
284.) Other references to the same object, might be made, for there 
is scarcely a writer of note among us, or elsewhere, who has viewed 
such cases in a different light ; but the above will suffice to show 
the opinion entertained on the subject by high authorities. 

The lungs become implicated in a number of diseases; in typhoid 
and typhus fevers, the complication is of great frequency, and has 
been long recognized as such, as the writings of Huxham 1 and others 
will fully attest. This eminent physician informs us, that at Ply- 
mouth, in 1740 and 1745, abundance of people were seized with 
shivering, then great heats, fever, and difficulty of breathing; impor- 

1 Essay on Fever, 59-61 ; Obs. on Air and Epid. Dis. ii. 59. 



AUTUMNAL FEVERS. 449 

tunate, laborious cough; very acute darting pains of the breasts, sides, 
and back ; frequent also in the head and temples. They had often- 
times a very quick, hard pulse, but concentrated, as it were. The 
breath was very hot and offensive, and the matter they expectorated 
was sometimes thin and crude; sometimes as yellow as saffron, but 
more commonly a thin, gleety, bloody matter; frequently very fetid, 
and sometimes so acrid as to cause a great hoarseness and soreness 
of the windpipe and throat, and sometimes excoriations of these 
parts. The blood drawn from them was either of a darkish-livid 
colour, covered over with a lead-coloured or greenish thin film, or 
sometimes quite florid (particularly on the first bleeding), but of a 
loose, soft consistence when cold. In others, the blood drawn was 
covered over with a pretty thick tough coat, " not of a whitish-yel- 
low colour, as usual in common pleuritic or pleuro-peripneumonic 
blood, but of a colour approaching to that of cornelian stone, or a 
little more dilute than that of the common jelly of red currants." 
The urine was commonly very high, and sometimes dark-coloured, 
with a kind of lead-coloured sediment ; it was generally rendered 
in small quantities. Faint, uncertain, partial sweats often attended, 
particularly about the face and head ; although many times, towards 
the fatal period, they were very profuse and colliquative. Livid or 
black spots frequently appeared about the state, and seldom or 
never failed of being the certain harbingers of death. 

Huxham remarks that, at the same time when this malignant 
peripneumonia reigned at Plymouth and its neighbourhood, pleuri- 
sies, peripneumonias, and pleuro-peripneumonias were everywhere 
epidemic, and generally of the true inflammatory kind, arising 
from the cold, dry, northerly and easterly winds, which had for a 
long time prevailed. " Now I must farther take notice," he con- 
tinues, "that contemporary with both these disorders, a contagious, 
putrid, petechial fever was very rife in and about this town, espe- 
cially among the sailors and prisoners, and those that were very 
conversant with them; and it was chiefly among those sorts of per- 
sons that the malignant pulmonic fever raged, so that this seemed 
to be a complication of the common inflammatory peripneumonia 
with the contagious petechial fever ; the contagious effluvia acting 
on the blood in the manner of acrimonious salts, and destroying its 
crasis." Montault 1 found inflammation of the lungs in twelve cases 

1 Mem. de l'Acad de Med. vii. 209. 

29 



450 PNEUMONIA AND 

out of forty-eight of typhus. Louis found it in somewhat more than 
one-third of his cases. 1 Attention was called to the complication by 
Sauvages, 2 by Fodere, 3 Chomel, 4 Bartlett, 5 Parr, 6 Low, 7 Hosack, 8 
Wood, 9 and a hundred others. 

In these cases, pneumonic symptoms are undoubtedly modified 
to a greater or less extent by the febrile poison, and the disease is 
not unfrequently wanting in the pathognomonic characters which 
serve to distinguish it when it exists alone. But in most cases the 
thoracic inflammation is easily distinguished, and is to all intents 
and purposes a pneumonia like every other pneumonia, bat often, 
though not always, partaking largely of the congestive rather than 
of the purely inflammatory character; but whatsoever be its cha- 
racter, it is something superadded to the typhoid fever, and form- 
ing no essential part of it. In the disease which, since the days of 
Sauvages, has very generally been denominated pneumonia ty- 
phoides, we have sometimes a primitive or pure pneumonia, which, 
as it progresses, assumes a low or typhoid character. It is then 
constituted of common pneumonia and a typhoid or malignant state 
of the system. But in other instances, the disease presents from 
the outset distinct symptoms of both pneumonia and typhoid or 
typhus fever. It is therefore a mere complication. Such was found 
to be the case during the prevalence of the disease in various 
parts of this country from 1807 to 1820. As remarked before, 
typhoid or typhus fever extended widely and fatally. It was 
attended occasionally, though not necessarily, with pneumonia; 
sometimes with inflammation of other organs, and not of the lungs. 
The latter, consequently, formed no essential part of the disease; 
and when it occurred, was a mere complication. Our countryman, 
Dr. Wood, has pointed this out in a most satisfactory manner. 10 
Dr. Hosack also well understood the nature of the disease. " You 
have," he says, " two opposite conditions of body to contend with — 
local inflammation on the one hand, and a typhus state of the whole 
system on the other. The causes of the disease are no less compounded 
than the disease itself. The local inflammatory affections are pro- 
bably occasioned by the sensible changes of the atmosphere, while 

1 De la Fievre Typhoide, i. 360. 2 Nosologia, i. 

3 Med. Leg. v. 351. 4 Lee. de Med. Clin. 

5 On Fever, 111. 6 Die. Art. Pneumonia. 
7 Med. Register, iv. 25. 8 Med. Register, iii. 449. 

9 Practice, ii. 39. l0 Op. cit. ii. 37. 



AUTUMNAL FEVERS. 451 

the typhoid character of the disease is derived from an epidemic 
constitution of the air, the same which has given rise to the typhus 
petechials, or spotted fever, which prevailed for some time past in 
our northern and eastern States, and which is doubtless the same 
disease as that now prevailing in Albany, with the exception that 
the present epidemic is complicated with the symptoms of local 
inflammation of the chest, brain, throat, &c, the effect of the pre- 
sent cold season of the year." 1 

The complication with relapsing fever was very common in Ire- 
land in 1847. 2 Like symptoms indicative of pneumonic inflammation 
have often been observed in the plague, and pointed out by many 
writers from the days of Riverius. 3 They occur in several eruptive 
complaints, in dysentery, and even in anaemia. Why should it not 
be so? Assuredly, if the lungs are susceptible of taking on morbid 
action through the effect of certain causes, in persons previously 
healthy, they cannot help being more likely to be so when the sys- 
tem is labouring under disease; and when all the organs and tis- 
sues, as well as the circulating fluids are, consequently, more alive 
to the influence of morbific agents. Nor is it difficult to under- 
stand how the inflammation, by which they are attacked, can 
awaken into activity a fever, the cause of which had lain dormant 
in the system, and which, when developed, continues to prevail at 
the same time with the disease already in existence, and modifies it 
to a greater or less degree. 

But these secondary attacks are mere complications; and it would 
be just as reasonable to regard, in Ireland and France, for example, 
where typhus and typhoid fevers are, as it were, endemic, all pneu- 
monias which occur in individuals affected with those diseases, as 
due to the causes of the latter, and as being in consequence really 
and substantially nothing more than a peculiar form of them, as to 
hold all pneumonias observed in paludal districts and during fever 
seasons, and presenting some or many of the essential characters of 
autumnal fevers, as the offspring of the paludal poison, or as a mere 
form of that class of complaints. Inflammation of the lungs, there- 
fore, when it presents itself in cases characterized by symptoms of 
periodic or autumnal fevers, is to be viewed in no other light than as 
a complication, and not as part and parcel of the fever in question. 

1 Obs. on Peripn. Typhoides, now prevailing in several districts of the U. S. 1813, 
Med. Regist. iii. 450. 

2 Dublin J. viii. 334. 3 De Feb. Pestil. ii. 95. 



452 PNEUMONIA AND 

Each, disease may, and often does exist independently of the 
other; but both may, and sometimes do coexist in the same 
subject; and while in such cases the febrile disease is due to its 
specific poison, the pneumonia arises from the same cause that 
would under any other circumstances have produced it. In 
such instances of complication, each of the two diseases may be 
simply modified by, or as it were tinged with, the other, i. e. 
a violent pneumonia may present feeble symptoms of an en- 
demic fever; or, vice versa, to a severe attack of fever may be asso- 
ciated symptoms of slight pneumonic inflammation. In some cases 
they start together. At other times the one precedes the other ; 
the former acting by enhancing the susceptibility of the system to 
the action of the cause producing the second ; or calling into play 
morbid conditions which before had lain dormant or latent in the 
system. To this it may be added, that while in some instances the 
pulmonary inflammation is subordinate to the fever, and, so long- 
as it has not reached beyond the first stage, disappears during the 
apyrexia of the intermittent form, to recur again with the accession 
of the fever ; and while it very greatly abates with the subsidence 
of the hot stage or exacerbation in the remittent, as proved by the 
general symptoms and physical signs, and follows, as it were, the 
phases of its associate ; in other and probably the larger number of 
cases, the disease only abates to a greater or less extent, but does 
not cease in the first-mentioned form, and does so but slightly in 
the latter, thus showing its independent existence. Finally, in such 
complications, it has not unfrequently happened, that the periodic 
fever has been arrested, while the local inflammation has continued 
to run its course, in the usual way, to recovery or death. 1 

The complication of diseases more or less distinct in their nature, and 
the modifying influence of epidemic over other complaints, are well known 
to etiologists and pathologists. — The fact of malarial fevers engrafting 
themselves on other complaints, and imparting to them the charac- 
ter of periodicity, is perfectly well known and genei'ally admitted. 
It is one of such frequent occurrence as to surprise no experienced 
and observant physician, and illustrates while it confirms what has 
just been said relative to the complication of pneumonia with 
some or more of the phenomena of autumnal fevers. The latter, 

1 Torti, 371, 476, 490, 495, 496; Hippocrates on Popular Med. Hist. vii. ; Mor- 
gagni, Letters, 31-33. See also Bailly, Mongellaz, &c. 



AUTUMNAL FEVERS. 453 

as well indeed as other epidemic and wide-spreading diseases, have 
a tendency to impress their livery on every intercurrent complaint, 
however dissimilar in character ; while they all, in their turn, 
not unfrequently become modified by other diseases that assume the 
epidemic garb and prevail in greater force. And I need scarcely 
remark, that such an effect can only be explained on the principle 
that such epidemic diseases, arising as they do from extensively 
diffused and powerful causes, complicate to a greater or less extent, 
and add a few or more symptoms to those appertaining to other 
diseases, by which individuals exposed to their morbid influences 
may be attacked. 

The effect has been noticed from the earliest times, even from the 
days of Thucydides, who remarks that the epidemic fever of Athens 
obliged all other diseases to change their nature by assuming some 
of its symptoms. " And none of the usual endemic maladies made 
their attacks during its continuance ; or, if they did, soon terminated 
in this." 1 It was pointed out in a particular manner by Sydenham, 
Hodges, Huxham, Storck, Lepecque de la Cloture, by our own 
Eush, and after him by other writers. See what takes place in 
regard to smallpox. If, in certain seasons, according to Sydenham 
and others, this disease prevails extensively, the fevers which ap- 
pear at the time assume an inflammatory character, come on like 
the variola, have kindred phenomena — less, however, the eruption — 
the same disposition to sweat, salivation, &c. Thus, in the epidemic 
smallpox of 1667, 1668, 1669, the continued fever which prevailed 
at the same time assumed the characters of that disease, and was 
" not much unlike it, except in the eruption of the pustules, and 
the symptoms thereon depending." There was pain over the pit 
of the stomach ; chills, headache, heat, absence of thirst ; the same 
appearance of the tongue and urine ; the same disposition to symp- 
tomatic and profuse sweat ; to petechise, when the antiphlogistic 
treatment Was not pursued ; the same tendency to salivation which 
occurred in the fever when the inflammation was violent and ac- 
companied the other disease when of the confluent kind. So alike, 
indeed, were the two diseases, in many of their phenomena, that 
" with the exception only of those symptoms which were the neces- 
sary effects and consequences of the eruptions, it was, if not identi- 
cal, at least closely akin to the smallpox." " Finally," says S., u as 
f 

1 Bk. ii. chap. 51. Bloomfield's Tr. i. 413. 



454: PNEUMONIA AND 

the fever was most rife at that particular time when the ravages of 
the smallpox were greater in these parts than at any other time 
within the limits of my own observation, there can be but little 
doubt as to the identity of character between the two diseases." 
" For this reason," says Sydenham, after recapitulating the whole, 
" although no man dislikes the coining of new names more than 
myself, I may, perhaps, be allowed to designate the present fever 
as the variolous fever, from its likeness to the smallpox or variola." 
The practical indications were manifestly the same in both diseases, 
those excepted* which the eruption of the smallpox and the symp- 
toms thence arising afforded, and which could not be expected in 
this fever, because it was not attended with an eruption. The disease, 
though it affected fewer persons by far than the smallpox, never- 
theless lasted as long; but in the winter, when that abated, this pre- 
vailed; and when the smallpox returned again in the spring, the 
fever went off, so as thus to leave the smallpox the predominant 
epidemic of the constitution of that period. The fever, notwith- 
standing, never manifestly ceased during this space, till at length 
it totally disappeared, together with the smallpox, in August, 1669. 
Notwithstanding these points of similarity, the fever could not be 
regarded as cases of smallpox without eruption ; for, as Sydenham 
remarks, they occurred indiscriminately in all classes, though 
principally among adults, the greater number of whom had, in all 
probability, passed through the disease. 

It may be useful to mention that, while this fever still survived, 
a diarrhoea, unaccompanied by any manifest febrile symptoms, was 
prevalent. It was worse in 1668. Sydenham says that at that 
time the constitution was tending towards the dysenteric, which 
was the character of the next coming years. He considered this to 
be the same fever with the variolous fever then rife, although it 
took another form, and exhibited itself with a fresh symptom. It 
was observed by him that chills and rigors preceded the diarrhoea. 
He also thought it evident that the diarrhoea itself depended on 
the same origin with the fever. Hence, he maintained that this 
fever arose from the inflammatory rays turned inwards towards 
the intestines, and so provoking them to repulsion. The blood in 
the meanwhile was freed by this division from those disorders 
which otherwise would have been caused by such rays. Besides 
this, the patient could not bear the pit of the stomach to be touched 
by the hand — a symptom common to both the fever and the small- 



AUTUMNAL FEVERS. 455 

pox of this constitution. All this made it as clear to him as the 
light of day, that the diarrhoea was of the same nature and essence 
with the dominant fever ; and this opinion was, he thought, con- 
firmed by the effect of venesection, and the cooling medicine, regi- 
men, and diet, which he found so advantageous in the fever. They 
cured the diarrhoea as well; whilst, if treated upon a different prin- 
ciple, it changed its character from a mild disease to a deadly one. 1 

The writings of Huxham contain accounts of several instances 
of similar complications. In 1729, in the month of July, the small- 
pox prevailed much at Plymouth ; and, during this month, a slow 
putrid fever, which remitted towards the end, and at length inter- 
mitted, became very epidemic there. It chiefly affected the head, 
stomach, and loins, as if the smallpox was coming on, and was at- 
tended with an oppression at the breast, sighing, and great languor. 
Perhaps it was such a kind of disorder that Sydenham called febris 
variolosa. Children, young people, women, and the more infirm, 
were more especially attacked with it. The blood drawn from them 
was seldom viscid; the urine commonly thin, crude, with an ash- 
coloured, mucous, and imperfect sediment, as if made up of wheaten 
bran. The more perfect the sediment, the more hope. The tongue 
was not very dry, but daubed over with a glutinous brown mucus. 
Near the end of the disease a diarrhoea, and sometimes a bloody 
dysentery, was greatly urgent. These were fatal to some. But a 
kind of red petechias, red miliary, itching pustules, or large sweats, 
breaking forth, most commonly quite carried off the fever. 2 Some- 
thing of the same kind occurred in 1740 ; the fever was modified 
by the smallpox. In 1745 and 1746 the contrary took place. The 
smallpox was modified by the typhus with which it was complicated. 3 

Diemerbroeck informs us that, during the prevalence of the plague 
in Nimeguen in 1635 and 1636, all the intercurrent diseases which 
showed themselves, assumed, before the close of twenty -four hours, 
the characters of the reigning epidemic ; and during a whole year, 
he continues, vix ullus morbus peste incomitatus visus fuerit. 4 Senner- 
tus observed, during the great plagues of 1616 and 1626, that nearly 
all other diseases disappeared ; and whenever any of them appeared 
and lasted a few days, it was sure to become complicated with the 

1 Vol. i. 151, 152, 157, 158, and edit, of Sydenham Society. 

2 Observations on the Air, and Epidemic Diseases, i. 39, 40. 

* Id. ii. 60, &c. 190, &c. Huxham on Fever, 3d edit. 131, &c. 
4 Tractatus, De Peste, 13. 



456 PNEUMONIA AND 

prevailing fever. " The plague," says Pugnet, " reigns alone. In 
saying this, I do not wish to convey the idea that, when in all its 
vigour, it puts a bar to the development of all other diseases, but ' 
that it stamps its characteristic features on those that show them- 
selves ; assuming, itself, the forms imparted to it by the tempera- 
ment of the individual attacked." 1 

A more recent and an excellent authority, who has often seen and 
studied the disease in Constantinople, remarks, that when the sickly 
season arrives, and the plague breaks out, it encounters, besides chro- 
nic diseases, those appertaining to the season, as well the sporadic as 
the endemic and epidemic. " If the plague is mild, the intercurrent 
complaints, and also those existing at the time, are uninfluenced in 
their progress. Sometimes, however, the regularity of their symp- 
toms is disturbed, and we notice a concealed plague, or a painless 
exanthema. If the plague is malignant, its deleterious influence 
complicates a large number of the reigning or intercurrent diseases, 
arrests the course or changes the character of their symptoms, in 
order to substitute its own. It dries up blistered surfaces, issues, 
and setons; alters the character of the pus issuing therefrom, 
causes abortion, &c. If the epidemic is violent, acute and chronic 
intercurrent diseases almost invariably experience its influence, and 
the mortality among those affected is very large. In seeing the 
plague ingraft its symptoms on those of the larger number of pre- 
vailing diseases, the public fancy that, before showing itself with 
its legitimate characters, the former was concealed under the form 
of those various diseases, and was the sole cause of them. The 
complaint is pronounced to be proteiform., and people are no longer 
astonished at the errors of the physicians ; while, in truth, the effect 
is only due to a deleterious influence added to the pre-existing dis- 
eases, and affecting the systems or apparatus of the economy with 
a force proportioned to the amount of their irritability. 2 

In speaking of the plague of London, Dr. Hodges remarks, that 
" at the rise of the plague all other distempers went into it ; but 
that at its declension, it degenerated into others ; as inflammations, 
headache, quinsies, dysenteries, smallpox, measles, fevers, and hec- 
tics, wherein the plague yet predominated." 3 Sydenham, whose 
observations extended over a period of sixteen years, including the 

1 Fievres de mattvais caractere, 135. See also Rapport de l'Acad, 52, 53, 62. 

2 Braver, Neuf Annees a Constantinople, ii. 289, 290. 

3 Loimologia, 26. 



AUTUMNAL FEVERS. 457 

time immediately preceding and following the great plague of Lon- 
don, calls attention to the fact that a remarkable change took place 
in the character of fevers and other complaints, approximating the 
general type of disease, in several striking features, to the distin- 
guishing characteristics of the pestilence at hand, some months 
before that dreadful malady assumed its distinct and proper shape, 
which it did at last quite suddenly. He remarks that the disease 
which precedes the plague changes its character, and is accompanied 
with a multitude of anomalous accidents. " It is like a monarch 
with a body-guard of foreigners." Such deaths from plague as 
sporadically occur during the few years following those of the 
great plague, and which gradually decrease and finally vanish alto- 
gether, are to be attributed to a partial persistence of the pestiferous 
disposition of the atmosphere, which has not yet undergone its full 
change from foul to healthy. Deaths, in years like these, are only 
the gleanings of the harvest that has gone before ; and it is from 
traces of former infection that the fevers of the first year or two 
after great plagues take a pestilential character; of true plague, 
indeed, they want some of the characteristics. Notwithstanding 
this, they resemble it exceedingly in character and disposition, and, 
as shown below, demand a similar line of treatment." (i. 99.) Again, 
in speaking of the epidemic coughs of the year 1675, he says: 
" And here I must again remark that, in the treatment of fevers, 
the physician who does not keep continually before his eyes the 
constitution of the year, the extent to which it favours the epidemic 
production of this or that disease, and the power it has of twisting 
to its own proper shape and likeness all the other concurrent dis- 
orders of the time, wanders widely in a maze without a clew." (i. 230.) 
Dr. Rush, in his account of the Scarlatina Anginosa, which pre- 
vailed in Philadelphia in 1783 and 1784, says: "Intermittent fever, 
which made its appearance in August, was not lost during the 
month of September. It continued to prevail, but with several 
peculiar symptoms. In many persons it was accompanied by an 
eruption on the skin, and swelling of the hands and feet. In some, 
it was attended with sore throat, and pains behind the ears. Indeed, 
such was the predominance of the scarlatina anginosa, that many 
hundred people complained of sore throats, without any other 
symptom of indisposition. The slightest occasional or exciting 
cause, particularly cold, seldom failed of producing the disease." 1 

» Vol. ii. 245. 



458 PNEUMONIA AND 

Dr. Southgood Smith has remarked that, during the six months 
immediately preceding the appearance of cholera in England, the 
character of fever in London so entirely changed, that typhus, 
which for a long series of years had been essentially an inflam- 
matory disease, became a disease of debility, so closely resembling 
cholera, that the fever into which cholera patients commonly fell, 
could not be distinguished from the primary fever found in the 
wards of the fever hospital when cholera was at its height, which 
had appeared there for the first time six months previously, but 
which has never disappeared since. 1 So also in all our yellow 
fever epidemics, every intercurrent disease assumed to a greater or 
less extent the character, and presented some of the phenomena, of 
the reigning complaint. 2 

The same absorbing power — the same influencing agency, is as- 
cribed by Desportes to the yellow fever of St. Domingo. Speaking 
of the epidemic which prevailed in the City of the Cape, in 1738, 
he informs us that the violence of the disease was such that it 
lulled all other diseases, and reigned alone. "This is the character 
of all contagious and pestilential diseases. Sydenham, and before 
him Diemerbroeck, had remarked it of the plague." 3 

Dr. Chisholm makes a similar remark in relation to the epidemic 
fever which prevailed so extensively at St. George, Grenada, in the 
year 1793. Most other diseases, he says, degenerated into or par- 
took very much of the nature of this. Dysenteries suddenly stop- 
ped, and were immediately succeeded by the symptoms of the pes- 
tilential fever. Catarrhal complaints, simple at first, soon changed 
their nature ; convalescents from other diseases were very subject 
to this, but it generally proved mild. Those labouring at the time 
under chronic complaints, particularly rheumatism and hepatitis, 
were also very subject to it. The puerperal fever became malig- 
nant, and of course fatal ; and even among pregnant negro women, 
who otherwise might have had it in the usual mild degree peculiar 
to that description of people, were reduced to a very dangerous 
situation by it. In short, every disease, in which the patient was 
exposed to infection, sooner or later assumed the appearance, and 
acquired the danger, of the pestilential fever. 4 

Dr. James Clark states that, in 1793, children, adults, and old 

1 General Board of Health's Report on Quarantine, 13. 

2 Rush, iii. 76, 79. 3 Maladies de St. Domingue, 40, 41. 
. 4 Op. cit. I 180-182. 






AUTUMNAL FEVERS. 459 

people labouring under smallpox, were attacked with the yellow 
fever about the time the secondary fever generally came on, whether 
the disease assumed the confluent or simple form. 1 Dr. Bush re- 
marks that the bilious remittent, or break-bone fever, which pre- 
vailed in Philadelphia in 1780, chased away every other febrile 
disease, or blended itself with the intercurrent diseases. 2 In his 
account of the measles of 1801, the same eminent physician states 
that the disease wore the livery of the autumnal fever in the fol- 
lowing particulars : " It was strongly marked by remissions and 
intermissions; the exacerbations came chiefly at night; there 
was in many cases a constant nausea and discharge of bile by 
puking." 3 

Dr. Balfour tells us that the intestinal remitting fever of Bengal, 
of which he has left us a graphic account, often appeared with 
symptoms of dysentery, rheumatism, and pleurisy. 4 In 1777, Clos- 
sot observed yellow fever associated with putrid typhus, and the 
union of two poisons in this way was noticed by Pringle and others 
in Europe, in the case of typhus and marsh fevers. The fever of 
Banker Street, New York, in 1820, was evidently a complication 
of bilious remittent and typhus — the idio koino miasmal fever of 
Dr. J. M. Smith. 5 

In the epidemic of Naples, in 1764, it was rare, as we learn from 
Sarcone, for other diseases, originating from causes different from 
those of the epidemic which scourged the city, not to pass finally 
into the latter. 6 Loew remarks that, during the petechial fever 
which prevailed in Presburg, in 1683, gout, colic, and sporadic dis- 
eases generally were often confounded or blended with the popular 
or epidemic fever. 7 

Dr. Blake, in his account of the climate and diseases of California, 
remarks that, although the influence of malaria does not show itself 
in the Sacramento Valley, " by producing any of the more marked 
forms of disease by which its presence is usually manifested, yet 
we have constant indications of its existence, by the character it 
impresses on almost every form of disease occurring in this lo- 
cality." 8 The yellow fever which prevailed epidemically at Tarn- 

1 Fever of Dominica, 19. 2 Vol. ii. 235, iii. 77. 

3 Vol. iii. 73. 

4 A Collection of Treatises on the Effects of Sol-lunar Influence in Fevers, 124, 125. 

5 On Epidemics, 57. 6 Maladies de Naples, ii. 59. 
7 Epid. de Morbo Petechiali, 5. 8 N. 0. Journ. ix. 510, 511. 



460 PNEUMONIA AND 

pico, in 1836, exercised a marked influence on all the intercurrent 
diseases which, in consequence, presented themselves, clothed with 
some of the symptoms of the reigning fever. 1 Experience, indeed, 
everywhere shows that remittent, intermittent, and yellow fevers 
are sometimes engrafted upon or blended with smallpox, scarla- 
tina, measles, dysentery, erysipelas, syphilis, scabies, hooping-cough, 
oriental plague, cholera, gonorrhoea, &c. 

Dr. Nepple, in his description of an epidemic of periodic fever 
which prevailed in the Canton of Dombes, in France, in 1823, states 
that almost every febrile disease was then attended with periodical 
paroxysms, which subsequently degenerated into true intermittent 
attacks. Bronchitis, which was very common, and of a v highly 
acute character during the winter, became complicated with nervous 
irritations, spasmodic dyspnoea of a more or less intermittent type, 
and with remittent paroxysms. Intermittent neuralgias were more 
than usually common. In a word, every disease appeared to have 
assumed a nervous and periodic character. 2 

The same phenomenon was observed at Auch some years later, 
where, independently of intermittent pernicious fevers which pre- 
vailed extensively, periodicity entered as an element in, or as a 
complication of the greater number of the intercurrent diseases, 
even in those which presented the inflammatory character, and in 
which physicians were more than once obliged to employ at the 
same time the lancet and the sulphate of quinia. 3 

The sweating fever prevailed epidemically in the Department of 
Dordogne, in France, during the greater part of the year 1841, 
affecting 10,803 individuals in a population of 83,342, and causing 
a mortality of 797, or 1 in about 5.5 of the sick. For two years 
previous, the Department (especially that part of it embracing the 
Cantons of Nantron, Kiberac, and Perigueux), was overrun with 
eruptive fevers — measles, scarlatina, smallpox, and varioloid. Gene- 
rally, one or two of these occupied the ground three or four weeks, 
and then made way for the others. In several instances, measles 
and scarlatina, or smallpox and varioloid, marched together ; while 
in some, all four existed at the same time. Under these circum- 
stances, the sweating fever made its appearance. In the course of 

1 Goupilleau, Bept. by Chervin, Bulletin de l'Acad. iii. 308. 

2 Ti\ des Fievres Interna. 137. 

8 Canipardon, Aper.ju sur les Maladies qui ont regne epidemiquement a Auch. Bul- 
letin de l'Acad. viii, 634. 



AUTUMNAL FEVEKS. 461 

the year — from the 7th of May to November — the disease broke 
out five times in as many different places, and disappeared; so that 
the epidemic, considered in its ensemble, appeared, as it were, in five 
instalments. On four of these occasions it assumed suddenly its 
legitimate garb, and immediately drove away all other diseases. 

On the fifth, however, things took a different tarn. All at once, 
after a thunderstorm, on the 7th of May, and the days following, a 
disease heretofore unknown broke out. It was very different in its 
nature and results from the measles, which then prevailed; but yet 
difficult at first to recognize, owing to its being under the depend- 
ence of the complaint it so singularly and suddenly came to replace. 
The disease no longer presented exactly the same train of pheno- 
mena, the same kind of pulse, or eruption. Nevertheless, there was 
in that new physiognomy of symptoms a family air which greatly 
puzzled the physicians. The measles were modified. To the pre- 
cursory febrile symptoms were added others which are strangers to 
the disease ; while others which belong to it disappeared unexpect- 
edly. Some days before, the patients had been seized with a chill, 
cough, coryza, and all the opening symptoms of measles. In some 
cases, one of these symptoms now gave way ; in others, a different 
one disappeared ; in all, the attack henceforward came on without 
the chill. Some, however, had a marked and well-defined rubeolic 
eruption ; while in others the skin became covered with a miliary 
eruption. 1 To this interesting fact may be added another, somewhat 
akin to it, derived from high authority ; that Storck and Lepecque 
de la Cloture mention epidemics of miliary fever, during which the 
pneumonias which prevailed terminated, not by expectoration, but 
by miliary eruptions, more or less abundant, or by fetid sweats. 

Diseases arising from various species of malaria mix together and 
form compounds. — Furthermore, diseases arising from the opera- 
tion of malarial effluvia, but having a separate and independ- 
ent existence, marked by distinct characters, and governed by 
different laws, combine with each other and present groups of 
phenomena which, though they have given rise to considerable 
discussion and been subjects of angry controversy, must be viewed 
as the effect of such complications, and not as mere modifications 
of one and the same disease. The amalgamation of typhus with 

1 Parrot, Histoire de la Suette Miliaire. Mem. de l'Acad. de Med. x. 395, 396. 



462 PNEUMONIA AND 

intermittent fevers, diseases which differ materially on many points, 
but approximate on others, has been noticed in some of our 
Southern States, the cases exhibiting clearly the symptoms of 
the former disease; while, at the same time, the type was periodic. 1 
Dr. Stoker, speaking of a number of cases of ague he treated in 
Dublin, some years ago, says that, "though the periodical revolu- 
tions which characterize agues were observable in these cases, still 
they were more or less under the debilitating influence of the 
same epidemic constitution, and also of the same moral and phy- 
sical causes which hitherto prevailed, and even at the same time 
impressed some cases of fever with the characteristics of typhus in 
an exquisite degree." 2 A like combination of true malignant yel- 
low fever with simple or double tertians, or other varieties of peri- 
odic or autumnal fevers of various types, the existence of which 
was recognized and pointed out upwards of a century ago by Pouppe 
Desportes, 3 has been dwelled upon with more or less emphasis by 
scores of our contemporaries, and of writers of the preceding 
generation. 4 Its occurrence, the assertion of a few physicians to 
the contrary notwithstanding, is indisputable, and may be cited as 
a satisfactory illustration of the compounds in question; while the 
circumstance of its being overlooked or undiscovered may be viewed 
as one of the principal causes of the error committed by those pa- 
thologists who regard the former disease merely as a higher grade 
of the latter. 

During the epidemic of yellow fever at Tampico in 1836, already 
referred to, intermittents, in particular, assumed this complicated 
form ; for, during the continuance of the epidemic, they almost in- 
variably presented, in addition to their legitimate symptoms, one 
or more of those appertaining to the yellow fever. 

The yellow fever which closed its epidemic career in Charleston, 
a year ago, was accompanied by and blended with the breakbone 

1 Du Pre, on the Antagonism of Disease. Charleston Journ. v. 607, 608. 

2 Pathological Observations, pt. ii. 163. 

3 Maladies de St. Domingue, i. 280. 

4 Lempriere, ii. 70 ; Osgood, 27, 28 ; Imray, Edinb. Journ. lxiv. 837 ; Rochoux, 
197; Nott, New Orleans Journ. iv. 586; J. M. Smith, on Epidemics, 310; Kelly, 
Anier. Journ. N. S. xiv. 376 ; Wood, Practice, i. 304 ; Chisholm, Letter to Dr. David- 
son, Med. Repos. v. 231, 232; Lewis, New Orleans Journ. ii. 292, 413; Id. iv. 154; 
Id. v. 40 ; Charleston Journ. ii. 696 ; Dickson, Essays, 152, 153 ; Id. Trans, of Med. 
Assoc, v. 252; Barton's Rep. 80; Bryson, 70, 84, 196, &c. ; Blair, 70; Heberden, 
385 ; Williams, i. 303, 362, 464, 625 ; Desruelle on Hooping-cough, 12 ; Halphen, 1, &c. 



AUTUMNAL FEVEKS. 463 

fever, or dengue, and well-marked eruptions of several varieties — 
pustular, papular, and exanthematic. The complication of dengue 
with remittent and intermittent fevers has been noticed by Dr. 
Arnold, of Savannah, 1 and by Professor Dickson, of Charleston. 2 
The like blending of remittent with typhoid fever is pointed out 
by Dr. Cain of the same city. 3 In a clever article on the Medical 
Topography of the Parish of De Soto, La., Dr. Gribbs speaks of 
cases of a mixed nature, which, " although affording all the usual 
indications of typhoid fever, displayed likewise the so-called mala- 
rial characters ; as evinced by the distinct intermissions which at- 
tended for several days, the icterode appearance of the skin and 
eyes, and the yellow coating of the tongue, with other symptoms 
of bilious derangement." 4 

In Blair County, of this State, typhoid fever prevailed exten- 
sively from the middle of January, 1852, to September. Sporadic 
cases occurred in other months, but the disease only assumed an 
epidemic character during the above-mentioned period. Dr. Coffey, 
of Hollidaysburg, remarks, that the cases that happened in the 
summer and fall, resembled strongly in their commencement remit- 
tent fever, and for which the inexperienced readily mistake them. 
" Indeed," says the reporter, " the manifestations of this disease are 
protean. It occasionally simulates intermittent fever." 5 Typhoid 
fever is on the increase at Kio Janeiro, where, as we have seen, 
malaria abounds; and we are told by Dr. Sigaud, that cases in 
which the symptoms of the disease are combined with those of 
periodic fever, are very commonly encountered. To such an extent, 
indeed, does the complication prevail, that it at one time occasioned 
the greatest confusion in the minds of many as regards the diagnosis 
of the cases, and led to much hesitation respecting the proper treat- 
ment to be pursued. 6 Similar complications of typhoid with inter- 
mittent have been noticed in France. 

M. Gauthier de Claubry, in his Eeport on the Epidemics of France 
during the year 1847, makes particular mention of the wide preva- 
lence of t} r phoid fever that year ; and states, as the result of observa- 
tions made in various parts of the country, that sometimes the disease 

1 Charleston Journ. vi. 332. 2 Trans, of Med. Association, v. 145. 

3 Ibid. 358. 

4 Fenner's Southern Reports, ii. 196, 197 ; see also Charleston Journ. v. 824. 

5 Trans, of Med. Soc. of State of Pennsylvania, iii. 75. 

6 Sigaud, Climat et Maladies du Bresil, 252. 



464: PNEUMONIA AND 

presented the phenomena of intermittence or rather of remittence. 
This was often attributed to the influence of accidental causes, as 
marshes, stagnant waters, with the more reason, indeed, because 
this modification in the symptomatology of .the typhoid affection 
occurred only in individuals placed directly under the influence of 
some of the above-mentioned causes, while the inhabitants of places 
situate far from marshes and stagnant waters, presented only the 
symptoms of ordinary adynamic or ataxic typhoid fever. 1 

Kuecker long ago recognized the complications of intermittent 
with malignant or typhus (probably typhoid) fever. 2 Pringle, on 
his side, regarded the morbus Hungaricus as a compound of bilious 
with hospital fever; and those who attentively examine the accounts 
we have of that disease, can scarcely refuse to admit that the 
opinion has the appearance of being well founded. 3 Indeed, it may 
be laid down as a fact of general occurrence, that when typhoid 
fever breaks out in paludal localities, after intermittents have there 
prevailed, the cases are frequently of a modified character, and 
assume a periodic type. And surely he would scarcely be listened 
to who maintained that all the diseases here enumerated, simply 
because they present themselves clothed with some or many of the 
symptoms of malarial fever, or impart some of their characteristics 
to these, must, therefore, be due to the cause giving rise to the 
latter, and are really and substantially nothing more than peculiar 
forms of one and the same complaint. An intelligent writer of one 
of our Southern States, after describing the several forms of fever 
of his neighbourhood, remarks, very pertinently : " Here are four 
varieties of acute disease, peculiar somewhat to certain terrestrial 
formations. Can any one possessed of candour and ordinary rea- 
soning powers, examine into their history, and fail to see the strik- 
ing characteristic differences. The enslaved and overtasked mind 
may reason, that, inasmuch as they are all fevers of the same season, 
appearing, blending, and mingling together, and often running into 
each other, specific distinctions cannot be made. To this kind of 
argumentation, we may properly reply, that red, white, black, 
green, are all colours. They may be so mingled and blended, run- 
ning into each other by imperceptible degrees, as to produce 
various shades, and associate in the mind a most intimate and 

1 Mem. de l'Acad. de Med. xv. 12. See also vol. xviii. 167. 

2 De Feb. Interm. Complicatione cum Maligna Casa, &c. 

3 Diseases of the Army, 188. 



AUTUMNAL FEVERS. 465 

inseparable connection ; yet, when they are displayed in their pri- 
mitive natural character, how boldly and prominently do they con- 
trast.'" Each of the diseases mentioned exists at times, and, indeed, 
generally, independently of the others ; some are the offspring of 
specific contagions poisons, and can in no way possible arise from 
the operation of other causes producing different complaints ; others 
are the offspring of non-contagious poisons ; others, again, arise 
from changes in the sensible qualities of the atmosphere. They 
blend together in very many ways, in their types and characters, 
under the conjoint influence of several concurrent causes ; and if, 
in their simple and uncomplicated garb, they must be held as 
idiopathic and independent disorders, they cannot cease to be so, 
when, to their own characteristic phenomena, are added some or 
more of those that appertain to malarial fevers. Now all this 
applies equally well to those cases which form more particularly 
the subject of our present inquiries ; for in the same way that mala- 
rious fevers are sometimes engrafted on typhus, plague, &c, so they 
may be, and often are, engrafted on serous, mucous, and paren- 
chymatous inflammations, and on that of the substance of the lungs 
among the rest. To say that such an occurrence is not possible, 
would be equivalent to maintaining, that a complication which 
undeniably occurs in regard to many diseases, even to some pro- 
duced by specific and contagious poisons, cannot do so in reference 
to thoracic inflammations. I leave to those who feel disposed to 
hazard the assertion, the task of explaining the reason of this ex- 
ception. If they succeed, we shall be forced to doubt the possibility 
of the coexistence of other morbid poisons in the same individual; 
for the evidence on which such coexistences rest is not a whit 
stronger than that adduced in favour of the complication of pneu- 
monia with malarial fevers. 

Diseases due to specific contagious poisons amalgamate together, or with 
other complaints, and form hybrid complaints, or exist together in the 
same subject. — Disprove satisfactorily the complication under con- 
sideration, and it will follow, that when writers, whatever be the re- 
spect usually accorded to their opinions and statements, tell us of the 
variolous poison being capable of coexisting with several other poi- 
sons — f its influencing their actions and being reciprocally influ- 

1 Lewis's Med. Hist, of Alabama, N. 0. Journ. iv. 165. 

30 



466 PNEUMONIA AND 

enced by them ; when they talk of smallpox existing in the same 
subject with scarlatina, hooping-cough, measles, miliary fever, psora, 
or syphilis ; when they affirm that hooping-cough and measles, the 
vaccine poison and syphilis, scarlatina and measles, or scarlatina and 
hooping-cough occasionally combine together ; when they cite cases 
in which typhus existed with erysipelas, scarlatina, vaccinia, psora, 
syphilis, or gonorrhoea ; when they describe the plague as sometimes 
existing in combination with smallpox, vaccinia, syphilis, or cholera 
Asiaticus: or of dengue uniting with scarlatina — influenza with the 
latter disease or measles — or syphilis with herpes or psora; when, 
in addition, they inform us of three distinct diseases, as smallpox, 
measles, and hooping-cough; or measles, scarlatina, and chicken- 
pox, running their course simultaneously ; when we are told that 
inoculation with a mixture of variolous and vaccine matters will 
produce, not, as Woodville stated, one or other of the two dis- 
eases, but both; when a case is cited on the authority of Leroux, 
in which the vaccine pustule was, as it were, imbedded in the 
variolous, and the matter of each, when used for inoculation, pro- 
duced its specific disease ; when, I saj^, they talk of such occurrences, 
we shall be j ustified in doubting the accuracy of their observations, 
and in maintaining that, instead of assemblages of distinct diseases, 
we have in all such instances really and substantially but one com- 
plaint, modified somewhat by peculiarities of season and weather, 
or other causes, but still to all intents and purposes the same. 1 

All these complications — all this livery wearing — all this amal- 
gamation of things distinct from each other, is now perhaps too 
well known, and generally acknowledged, by those whose attention 
has been drawn to the subject, and who are, in consequence, best 
qualified to form an opinion upon it, to have required any length- 
ened remarks in this place, were it not that some writers among us 
and elsewhere, who are not backward in severely criticizing and cast- 
ing ridicule on the views of physicians of high authority, and who 
charitably undertake to set the whole professional world right on 

1 See, on these various combinations, Nott, N. 0. Journ. March, 1848, p. 586; Dick- 
son, Trans, of Med. Assoc, v. 142, 143; Williams on Morbid Poisons, i. 40, 120, 211, 
212, 264, 301, ii. 38, 65, 191, 296, 623; Holland, Connection of Diseases, 58, Am. ed. 
64 ; Blair, 70 ; Heberden, 385 ; Fodere\ Med. Legale, v. 352-357 ; Lafont-Gouzi, Mate- 
riaux pour servir a l'Hist. de la Medecine Militaire, &c. 47-83 ; Sarcone, Mai. de Naples, 
ii. 225; Anglada, Traite de la Contagion, i. 331, 332, 334, 336; Adams on Morbid 
Poisons, 11, 13; Bousquet, Traite de la Vaccine, 300; Robertson, a General View of 
the Nat. Hist, of the Atmosphere, ii. 370. 



AUTUMNAL FEVERS. 467 

knotty points of pathology and etiology, appear to have lost sight, 
or to be ignorant of the true explanations of the occurrences 
alluded to. If they have forgotten, they must be reminded, and if 
they do not know, they cannot fail to be benefited by the informa- 
tion, that the Hunterian maxim, which teaches that no two different 
fevers can exist in the same constitution 1 — a maxim from which Bar- 
thez started, in establishing his doctrine of the distraction of forces, 2 
and about which so much has been said — is unfounded ; that though, 
in most cases, one of those diseases acquires the supremacy over 
the other, and either expels it or keeps it in check, in other in- 
stances, they progress simultaneously; that this takes place even 
in relation to eruptive fevers, a fact denied by Hunter ; and that 
the whole of what has been remarked in the preceding pages is 
conformable to certain laws which should not be overlooked by 
those who undertake to describe the true and fundamental cha- 
racters of diseases, and to assign to these their nosological position. 
When they come to investigate the subject as it deserves to be in- 
vestigated, they will find that intercurrent, endemic, or even epi- 
demic diseases, are influenced not only by the meteoric constitution 
of the period at which they appear, but that their characters, pheno- 
menal and anatomical, are constituted at the outset of those apper- 
taining to them, and also, to a greater or less extent, of those 
transmitted by complaints arising from anterior medical constitu- 
te tions or reigning causes ; and toward the close of their preva- 
lence, of those characterizing succeeding complaints. They will 
find that such diseases seldom manifest themselves in their pure 
and unmodified garb except towards the middle of their career of 
prevalence, when the influence of anterior and succeeding constitu- 
tions or morbid causes is not felt ; that what takes place in the 
same locality during different periods occurs at the same epochs in 
different localities — diseases which retain their purity of character 
in particular places, losing it as they reach other places where dif- 
ferent morbid influences prevail ; and that much the same results 
obtain in regard to diseases which attack individuals exposed to 
other morbid influences elsewhere, or in the same place at other 



1 On the Blood, introd. 13. Am. ed. 

2 Nouv. Elem. de la Sc. de l'honime, ii. 181. 

3 See on these subjects Boudin's Geographie Medicale, 22, and Fuster's very excel- 
lent work, Des maladies de la France dans leurs rapports avec les saisons, 193-199. 



468 PNEUMONIA AND 

" This fact," as Dr. J. M. Smith observes, " was specially remarked, 
by Sydenham and Hodges, of the disorders which preceded the 
plague of London in 1665. Similar instances are recorded by Bel- 
linus, 1 Yan Swieten, Bayley, 2 and, indeed, by most writers on 
pestilential epidemics. Dr. Mead sums up these facts in the general 
observation, that fevers of extraordinary malignity are the usual 
forerunners of plagues, and the natural consequence of that state of 
air which attends all plagues. Part 1, ch. I." 3 

Pneumonia, like other inflammations, sometimes assumes a periodic 
type, independently of a malarial influence. — Most of the instances 
mentioned are doubtless the effects of the complication or blending 
of distinct diseases. But while admitting this to be the most proper 
explauation of the amalgamation of the phenomena they present, we 
must not lose sight of the circumstance that the inflammation of the 
lungs, like other acute affections, has a tendency in some cases to 
assume a remittent or intermittent type. That such a tendency may 
be noticed in that disease is a fact which we might d priori con- 
clude; for there are but few cases in which symptoms of febrile 
reaction do not exhibit a diurnal abatement and aggravation more 
or less marked, or do not present every second or third day a more 
decided change of the same kind. As stated on a former occa- 
sion, the existence of a good and bad day is evidently recognizable 
in most cases of pneumonia ; and I presume it may safely be averred 
that a decided remission is only a considerable diminution, and an 
intermission only a temporary cessation of the morbid condition 
existing during the abatement referred to. These remarks are 
equally applicable to other inflammations and irritations, where- 
soever they may be seated, and by whatsoever cause they may be 
produced. This tendency to decided remissions and intermissions, 
occurs more frequently during the prevalence of the cause of pe- 
riodical fevers, which modifies the morbid process, and imparts to 
it the element of periodicity, without, however, being sufficiently 
energetic in its impression, or meeting in the system with a suffi- 
cient degree of susceptibility, to produce a decided attack of fever, 
or even to give rise to the development of some of the more marked 
symptoms of the latter. But cases of the kind have occurred when, 

i Webster, ii. 44. 2 Fever of New York, 1795. 

3 Smith on Epidemic, 170, 171. 



AUTUMNAL FEVERS. 469 

from the non-existence of periodic fevers in the vicinity, it was 
impossible satisfactorily to refer the effect to the agency of the 
admitted cause of such diseases, and under circumstances which 
precluded the supposition of its arising from the development of a 
morbid agent lying dormant in the system. 

The manifestation of this tendency in pneumonia cannot, there- 
fore, lend support to the idea of identity, as regards causation and 
nature, of that disease with malarial fevers, of which periodicity, 
partial or complete, constitutes a characteristic element ; unless we 
are prepared to assert that all diseases in which we notice perfect 
or imperfect remissions — whether observed in districts of country 
subject to malarial complaints, or in places totally free from these — 
are the products of the same cause as remittent and intermittent 
fevers, and consequently really and substantially nothing more 
than peculiar forms of these. From this the strictest medical unit- 
arian will doubtless shrink ; for he must have seen — or if he has 
not, others have — cases afar from any malarial influence, in which 
irritation produced by mechanical or kindred causes, has been 
attended with, or followed by, febrile symptoms characterized by 
decided remissions, or, indeed, intermissions. Every one knows 
that the introduction of a bougie into the urethra has sometimes 
produced that effect. Bartholin, Forestus, Pollini, Eoederer, Mon- 
gellaz, and others, relate cases of intermittent diseases occasioned 
by the irritation of intestinal worms. Frank relates, from Schmac, 
a case of the same kind, resulting from swallowing a piece of lard. 
Frank himself saw the same effect produced by mushrooms. A 
case fell under my own observation, some j'ears ago, in which six 
febrile paroxysms were produced by the ingestion of a peach-stone. 
In this instance there could have been no malarial taint. Dr. Evan- 
son, in his work on the Diseases of Children, 1 mentions a case in 
which febrile paroxysms of a remittent type, which lasted several 
days, occurred in a child, from swallowing a marble. The symp- 
toms made their appearance soon after the occurrence, and were 
suddenly cured by the expulsion of the irritating cause. The same 
effect has resulted from the formation in the stomach of a cheesy 
coagulum, and was cured by its expulsion. 2 Dr. Pascalis describes 
intermittent paroxysms resulting from the irritation of decayed 
teeth ; the elder Frank from a gumboil, &c. Other examples of 

i P. 243, Am. ed. 

2 See Copland's Diet. ii. 1120; Stewart, Dis. of Children, 127. 



470 PNEUMONIA AND 

the same import might easily be adduced ; but the task is unneces- 
sary ; experience daily showing, that morbid irritations, by whatso- 
ever causes produced, and in whatsoever organic apparatus or system 
of the economy situate, may, and often do assume the remittent and 
intermittent types. These are observed in irritation of the red 
capillaries, inflammatory and hemorrhagic; in sub-inflammatory 
and nervous irritations. Of all these, examples may be found in 
works of easy access. In a word, there are facts enough afloat, to 
prove that the element of periodicity does not belong exclusively 
to febrile diseases of a malarial origin. 

So far from it, the periodical is as much a natural type as the con- 
tinued. It characterizes many of the phenomena of health, and ex- 
hibits itself in the physiological play — both as regards progress and 
intensity— of many of the functions; in the processes of secretion, 
elimination, and calorification ; in the operations of the nervous 
system ; in muscular contraction ; in the action of the heart, &c. 
Intermittence, indeed, may well be viewed as an element essential 
to the existence of the normal actions of the economy. What is 
more, it adheres to these actions in their passage from the state of 
health to that of disease, and may, therefore, be recognized as an 
element of this state also. It stands as an illustration of the great 
law of periodicity which regulates all the vital movements. This 
law has elicited, as we have seen, the attention of medical and phy- 
siological observers from an early period of our science, and has 
not been neglected in modern times. An American writer, the late 
Dr. Carpenter, of New Orleans, has, among others, pointed this 
manifestation of intermittence in the functions, and after showing, 
as Dr. Laycock had done already, that the periodicity of these is 
governed by a power or agency inherent in the system, and only in a 
secondary manner dependent upon the physical influences which sur- 
round us, properly remarks : "This principle once established, it be- 
comes an easy matter to account for the intermittence of disease, by 
referring it to the persistent and controlling influence of these phy- 
siological oscillations, whose periods and intervals continue to mark 
and measure its stages and paroxysms. The matter of surprise and 
inquiry will then become, not why some diseases are intermittent 
in their course, but rather, why it is, that all of them are not so ? m 

1 New Orleans Med. Journ. iii. 428. See, on this subject, Bichat, Anatonrie Gene- 
rale, Lois d'Intermittence, i. ; Holland on Morbid Actions of Intermittent Kind, 
Medical Notes, 193, Am. ed. ; Mongellaz, Essai sur les Irritations Intermittents, vol. 
i. 3-5 ; N. A. Med. and Surg. Journ. i. 327. 



AUTUMXAL FEVERS. 471 

Surely, when we take all these facts and circumstances into consi- 
deration, we cannot but perceive the impropriety of concluding, 
from the occurrence of remissions and even full intermissions in 
pneumonia, that the disease must necessarily be the offspring of the 
cause which gives rise to periodic fevers, and nothing more than a 
peculiar form of the latter. 

The success of the anti-p>eriodic treatment in pneumonia — supposing it 
true — no proof of the identity in question. — For these reasons, I am not 
prepared to admit that, in managing a case of pneumonic inflamma- 
tion, "we must not lose sight of the fact that we are dealing with 
a constitutional disease — with a periodic fever — which is to be re- 
lieved by quinia, or to adduce, from the supposed beneficial effects 
of that remedy in the disease in question, an argument in favour of 
the identity contended for. This argument may be traced far back 
in the history of our science, when every disease that was cured 
by bark was supposed to partake of the nature of an intermittent 
fever — to be, in fact, only a periodic fever in disguise. The prac- 
tical advice above referred to can, at most, apply to some cases only, 
and certainly not to all. In the large majority of instances of pneu- 
monia, as observed everywhere — even in very many of those seen 
in the South — the physician will have no reason to bear in mind 
what Dr. Merrill lays so much stress upon. The disease is in no 
way connected with periodic fever. It is a constitutional affection 
in this sense only, that the system at large becomes implicated in 
the morbid disturbance by nervous and arterial reaction. In that 
respect it is closely allied to all other complaints in which import- 
ant organs or tissues become, from some cause or other, the seat of 
inflammation, and in which, unless the powers of life are crushed, 
from the outset, and placed beyond the possibility of reaction, febrile 
phenomena set in. Hence, the principal object in the treatment 
will be, not to cure the constitutional disease, but the local inflam- 
mation and its various complications ; because, on the disappear- 
ance of these, the case will come to an end. Supposing, now, that 
some cases get well under the use of quinia, the result could not 
prove the connection suggested. Before adducing that success for 
the purpose in, question, it would be necessary, first, to demonstrate 
beyond doubt the reality of the benefit to be derived from the 
remedy, or rather of the superiority of the method proposed, if not 
the indispensable necessity of resorting to it ; and secondly, to show 



472 PNEUMONIA AND 

how, admitting the results to be as advantageous and marvellous 
as the warmest advocates of the method represent them to be, they 
can in any way serve to prove the dependence of thoracic inflam- 
mation upon ordinary periodic fever. 

Now, as to the former of these points — the great benefit or supe- 
riority claimed for the quinia practice, when resorted to during 
the abatement of febrile excitement in pneumonia — I cannot greatly 
err, when expressing the opinion that many, very many practitioners, 
in all parts of the world, who have seen much of the disease, and 
acquired the needful skill in its management, will feel no disposi- 
tion to join in singing the praise of that method, or to adopt it to 
the exclusion of the one they have heretofore employed. They 
will say, and I suspect that statistical returns will bear them out in 
the assertion, that while autumnal fevers, especially when they 
assume the truly periodic type, call, in some of their stages, for the 
use of anti-periodics, and more particularly of quinia, it is very 
far from being proved that the same will hold good with regard 
to pneumonia and kindred thoracic inflammations, which are, to say 
the least, cured just as well without as with the aid of the salts of 
bark; that in their usual form they yield to antiphlogistics, gene- 
ral and topical, and to revulsives, or even, in some instances, to the 
powers of nature; that, in the majority of cases, the quinia prac- 
tice would be not only useless but hazardous, and should on this 
account be avoided ; that, as a general rule, the remedy, if used at 
all, can only be so after other means of a different or opposite kind 
have been resorted to ; and that, when these have been properly 
timed and judiciously employed, the disease seldom requires the 
aid of tonics, still less of those possessing an anti-periodic power. 
They will say, besides, that when tonics are called for, it is not in 
virtue of their anti-periodic effects; that as much advantage, if not 
more, is derived from other articles of the materia medica; and 
that, when the disease assumes the typhoid form, it may be more 
successfully treated by local depletions and revulsives, or by the 
latter without the former, together with stimulating diaphoretics and 
expectorants, and sometimes with stimulants and tonics. Finally, 
they will say that, when the latter are required or admissible, quinia 
will often answer a good purpose ; but that it is doubtful whether 
it will be more serviceable than other articles of the materia 
medica. In all this, the majority of professional men throughout 
this country and in Europe will, I have little doubt, acquiesce. 



AUTUMNAL FEVERS. 473 

In these parts, where, I should presume, the treatment of pneu- 
monic inflammation is as well understood, and as successful, as it 
is in any other section of the world, I feel confident that few physi- 
cians of note would be disposed, from experience, to resort to quinia 
or other kindred remedies at any but the last period of the disease, 
or when signs of prostration or relaxation of the powers of life 
manifest themselves. But in such instances they would prescribe 
it on very different principles from those advocated by Dr. Merrill ; 
and I think it might be shown that the same sentiment is enter- 
tained elsewhere, even in the very section of country where he has 
acquired the larger share of his experience. 

To this it may be added, that the claim set up in latter times for 
quinia, of being a powerful and pure counter-stimulant or sedative 
— especially when administered in large doses — an opinion which, 
originating in Italy some thirty years ago, has received the support 
of several French, English, and American physicians, 1 is not, after 
all, sufficiently authenticated, so far, particularly, as relates to dis- 
eases produced by causes different from ordinary malarial exhala- 
tions, to justify a resort to the remedy in the treatment of pneu- 
monia so long as signs of inflammatory irritation exist. Admitting, 
therefore, that all we have heard, and continue to hear, concerning 
the manifestation of that property, and of the wonderful effect result- 
ing from it in periodic fevers, of all possible grades, types, and 
forms — to say nothing of dozens of other complaints, the number of 
which seems to enlarge with every succeeding writer, in some sec- 
tions of our country — were placed beyond the possibility of doubt, 
the fact would not help those who, from a supposed similarity of 
effect of certain remedies in certain diseases, venture the conclusion 
that those diseases are similar ; for it is yet to be proved, by correct 
clinical observations, that quinia exhibits that property, and is re- 
markably successful in pneumonia. Kay, more, supposing these 
wonderful effects, both as regards the latter disease and malarial 

1 Bailly, Traite des Fievres Interm. 1825, p. 424 ; Guersant, Diet, de M6d. xxvi. 564 ; 
Gere-mini, Annali Univ. de Med., March, 1841; Blair, 107; Drake, 746; Bell's Lec- 
tures, ii. 782 ; Boling, Am. Jo-urn. N. S. viii. 89 ; Fenner, New Orleans Journ. v. 208 ; 
Id. 9, 318, &c. ; Id. Southern Reports, ii. 849 ; McCormick, New Orleans Journ. ii. 175 ; 
Holmes, A. J., N. S., xii. 304; Merrill, New Orleans Journ. viii. 161, 163; Upshur, 
Stethoscope, ii. 437 ; McCaw, Stethoscope, ii. 666, &c. ; Desiderio, Comptes Rendus 
de VAcad. des Sciences, ix. 509; Bally, J. Gen. de Med. Oct. 18, 1829, p. 7; M6rat 
et Delens, Diet, de Mat. Med. v. 607; Jacquot, Arch. Gen. 1845, vi. 76; Briquet, 
Traite Therapeutique du Quinquina, 21, 42, 107, 123. 



474 PNEUMONIA AND 

complaints, to be such as they are represented in certain quarters; 
supposing that quinia is a decided sedative; that it is a perfectly 
harmless remedy ; that by its means fevers may be cut short at the 
outset; supposing that it may be safely, and, indeed, beneficially 
employed in large and repeated doses throughout the attack of 
these diseases, or before the complete cessation of febrile reaction, 
and that analogous effects may be expected to result, and are ob- 
tained, in pneumonia, it is difficult to perceive how, from these 
circumstances, a proof of the identity of this disease with fever can 
be derived. 

Not only does the success of quinia in the latter fail to indicate 
that the same result must necessarily attend the employment of the 
remedy in pneumonia, but success in both complaints would lend 
no help to the advocates of the identity in question. In the first 
place, no fault can be found with those who in the present state of 
the question at issue, are skeptical as to the wonders related of 
quinia, and feel disposed to question the propriety of administering 
very large doses of it at the commencement of a febrile attack, 
without waiting for a marked remission, and especially during the 
continuance of high arterial action and symptoms of local inflam- 
mation or irritation ; for, after all, this practice, for which Dr. Dun- 
das 1 claims credit, but for which the profession in this country was 
long before his time indebted, some say (for this important point, 
if important it really be, has not yet been satisfactorily settled, there 
being several claimants in the field) to Dr. Thomas Fearn, 2 of Ala- 
bama ; others to Dr. Metcalf, 3 of Miss. ; and some, again, to Dr. Per- 
rine, 4 of the same State ; this practice, I say, though it enumerates 
warm and respectable advocates both on this and the other side of 
the Atlantic, 5 cannot be said with certainty to have proved, in the 

1 Sketches of Brazil, 287, 291, &c. 2 Fenner's Southern Reports, ii. 346. 

3 Id. i. 352. 4 Amer. Journ. xi. 250. 

5 Drake, Western J. xi. ; Ib. Dis. &c. of the Valley, &c. 775, 789 ; May, Transyl. 
3..X. ; Van Buren, Examiner, 1846; Upsher, ib.; Maillot, Fievres Interm. 11, 140, 
362 ; Broqua, Mem. sur le Sulf. de Quinine, Bulletin, vi. 619, 749 ; viii. 624 ; Fletcher, 
Med. Times and Gaz. April 23, 1853, p. 422 ; Ib. Braithwaite, pt. xxvii. 264, Am ed. ; 
R. Gee and W. Eddowes, Lancet, Sept. 1853, p. 210, Am. ed. ; Cummins, ib. 218; 
Sigaud, Climat et Maladies du Bresil, 245; Briquet, Traite Therapeutique, 339, 358, 
366; Tuck, N. 0. J. ii. 303; Mitchell, ib. iii. 16; Merrill, ib. viii. 161; Fenner, ib. v. 
209; Ib. ix. 318; Ib. Southern Med. Rep. i. 118; Ib. ii. 98; McCraven, N. 0. J. v. 
234; McCormick, N. 0. J. ii. 173; Coolidge, South. Med. Rep. ii. 449; Haspel, Mai. 
de l'Alg^rie, ii. 332, &c. ; Manson, Stethoscope, iii. 135. 



AUTUMNAL FEVERS. 475 

hands of every good and safe practitioner, as advantageous, except 
perhaps under exceptional circumstances, as its originators and 
partisans so confidently assert. 

To whomsoever the bright idea may have suggested itself among 
us, the practice is evidently but a revival of- the one suggested and 
resorted to as early as the close of the seventeenth century, by 
Morton — adopted not long after by Torti, Burserius, "Werlhof, 
Trnka, and other physicians of the times, and highly eulogized, 
so far at least as regards its applicability to yellow fever, by 
Arejula, Sarravia, Lafuente, Bobadilla, and the majority of Spanish 
physicians, as well as by Yalentin, Cassan, Lefoulon, Guyon, Sava- 
resi, Stevens, Kuhn, &c. — of administering the Peruvian bark in the 
largest possible doses, in all stages of the disease, after little prepa- 
ration, or without any preparation at all; and we all know that the 
success obtained from it, though satisfactory in a few cases, has not 
been such as to encourage its general adoption. The theoretical 
views upon which the practice was predicated were, doubtless, some- 
what different from those by which the advocates of the quinia 
treatment, above referred to, are guided ; but the effects claimed are 
similar. Forget for a moment that the writers cited are speaking 
of cinchona, and not of quinia, and you may fancy that the latter 
remedy is the subject of their remarks. Upon the administration 
of a large dose, it was said, the pulse is reduced ; the skin cools 
and moistens ; thirst, if it existed, disappears ; the tongue becomes 
clean and moist; in a word, fever disappears as by enchantment; 
and if the patient experience a little uneasiness about the head, a 
little dizziness, perhaps a slight buzzing in the ears, the whole soon 
subsides, and convalescence follows. Such were the effects claimed 
for bark, in the class of disease in which the quinia, used in the 
way mentioned, is said to act as by magic. Is not the fate of the 
former practice calculated to raise some doubts as to the perma- 
nence of reputation of the latter? 

Let it be said, en passant, that experience will doubtless one day 
demonstrate, to all whose eyes are not blinded by theory, that more 
noise has recently been made about the abortive plan of treating 
febrile diseases by means of scruple or even larger doses of quinia, 
given, with or without preparation, at the outset of the attack, with 
the intention of arresting their progress, than is warranted by the 
nature of the results obtained. Entitled as the authority of many 



476 PNEUMONIA AND 

of the advocates of the plan may be to our respect, it may be 
fairly suspected that, in singing its praise so loudly, and pro- 
claiming its superiority over every other heretofore pursued, they 
have allowed their imagination to get somewhat the better of 
their judgment. To this conclusion I am the more inclined, be- 
cause it is yet to be proved that remittent and yellow fevers, when 
once established, can be arrested in their course ; and the practice 
has failed, and even proved detrimental, in the hands of other 
observers, so far especially as regards the yellow fever. 1 Besides 
this, several of its more zealous advocates would extend the prac- 
tice to every other form of fever named in the books — typhus, 
typhoid, &c. — in which, when resorted to by other equally skilful 
physicians, in this country and elsewhere, quinia, as an abortive, 
sedative, or specific, has failed to produce the anticipated effect, 2 
unless perhaps the disease had assumed a decidedly remittent or 
intermittent t}^pe, when it required no prophet to tell us it would 
be useful. It is true that, by the warm supporters of the plan in 
question, no heed is taken of the opposition it has encountered ; 
but on inquiry we cannot find that any stronger reason has been 
assigned (and, taking all things into consideration, it cannot but 
appear extraordinary that something better could not have been 
offered) for the failure experienced, even with what might well be 
regarded as classical doses of the panacea, than that physicians who 
recount their ill success would have obtained opposite results had 
they only given the quinia a fair trial; in other words, adminis- 
tered it earlier and in larger quantities. To those who have no 
hobbies to ride, the fact of these repeated failures, to say nothing of 
certain analogies they may bear in mind, and sundry theoretical 
views they may entertain respecting the pathology of the disease, 
and the mode of operation of the remedy, will be sufficient to 
deter them from joining in the hosannas sung in some quarters; 
while the allegation that southern and western physicians, who, we 
should think, cannot be accused of over-timidity in the use of reme- 

1 Stone, N. 0. J. ii. 184, &c. ; Dickson, Charleston J. i. 14; Lewis, N. 0. J. i. 425, 
427; lb. iv. 174; N. 0. J. x. 279 ; Furlonge, Lancet, Dec. 1853, p. 441, Am. ed. In 
this city, last autumn, the quinia practice failed completely. 

2 Gibbs, Fenner, ii. ; Boling, N. 0. J. ix. 2, &c. ; Maggibbon, N. 0. J. x. 25, 36 ; 
Scruggs, N. 0. J. x. 206; Gordon, ib. 146, 210; Fletcher, Braithwaite's Abstract, 
July, 1853, p. 264; Grant, Am. J. xxvi. (N. S.) 104; Barclay, Med. Times, Jan. 8, 53. 



AUTUMNAL FEVERS. 477 

dial agents — witness the history of calomel, tartar emetic, and the 
lancet, among them — have not been struck with the success of the 
abortive method, simply because they had not been heroic enough 
with quinia, which the most cautious among them daily use in 
doses which cause astonishment in excellent and skilful practitioners 
elsewhere, will appear passing ludicrous, and may recall to their 
minds, as it has done to mine, a certain passage in Gil Bias, in 
which the great Sangraclo — the worthy prototype of more than one 
physician of an era not very remote from our own — accounts for 
the loss of the Canon Sedillot, whom he had, as a matter of course, 
bled profusely and deluged with warm water. I quote the original : 
" Comme il rendait les derniers soupirs le medecin parut, et demeura 
un peu sot, malgre l'habitude qu'il avait de depecher ses malades. 
Cependant loin d'imputer la mort du chanoine a, la boisson et aux 
saignees, il sortit en disant d'un air froid qu'on ne lui avait pas fait 
tirer assez de sang ni fait boire assez d'eau chaude." 1 

I am aware that the experiments of Bricquet and others show, 
that the sulphate of quinia, when given in doses of fifteen grains or 
upwards, has a tendency to reduce very considerably the frequency 
and force of the circulation; and that a similar effect is also obtained 
in lower animals, whether the remedy be administered by injection 
into the vessels, by the stomach, or by insertion into the cellular 
tissue. 2 I am aware, also, that this depressing action of quinia 
has been very frequently observed in this country and in Europe. 3 
But while we admit all this, and feel convinced, besides, that many 
physicians, among us especially, have heretofore been too timid in 
the administration of the article, have used it in too small doses, 
and postponed it too long ; that it is better to give it in a few smart 
doses, than in small and repeated quantities ; and that, in some 
cases, it is tolerated, and has produced excellent effects in very large 
doses ; nevertheless, it is impossible to shut our eyes to the fact 

1 Liv. ii. chap. ii. 

2 Comptes Rendus des Seances de l'Acad. des Sci. xxvii. 549 ; lb. Reflexions sur 
1'emploi du S. de Q. a hautes doses, Bulletin, viii. 898 ; lb. Traite Therapeutique, &c. 
21, 42. 

3 Briquet, Traite Therapeutique du Quinquina, 21, 42, &c. ; Bally and Banquier, 
J. Gen. de Med. Oct. 1829, p. 7 ; Jacquot, Arch. Gen. 1845, vi. 76 ; Lambert, 
Essai sur la Methode Endermique, 97 ; Guersant, Repertoire des Sc. Med. art. Quin- 
quina ; Legroux, Journ. de Med. et de Chir. Pratiques, April, 1845 ; Boucher, Sur 
1'emploi du S. de Q. dans la Fievre Typhoide. These, 1846. See others, mentioned 
above, at p. 173. 



478 PNEUMONIA AND 

that this sedative action does not always manifest itself; that 
quinia not unfrequently increases the force and activity of the cir- 
culation ; that when the sedation is produced, it is for the most part 
secondary, and akin, as Guersant, McCaw, and others remark, to 
that occasioned by overpowering portions of alcoholic or other 
stimulants, or to the after effect of lesser doses of these ; that it is 
preceded by a stage of reaction — in short, it may be, but too evident 
to be denied — that when produced, the depression of the circulation 
is obtained at the expense of the brain and nervous system (of 
which it is far from being a true sedative), and of the gastric and 
sometimes the entire mucous membrane, on which it operates as an 
irritant ; that in ordinary, if not in all diseases, the existence of 
inflammation is generally found by pl^sicians entitled to the fullest 
credit, to prove a bar to its production, and that this morbid condi- 
tion is apt to be aggravated by the free use of the remed}^. All 
this is so evident, that we may venture the remark that experience 
will, before a very long while, prove, to the satisfaction of all candid 
observers, that those who carry the vaunted abortive plan to the 
extent recommended; those who use quinia in very large doses, 
without regard to the existence of inflammation, and prescribe it 
as well during the exacerbation of febrile complaints as during the 
apyrexia, run the risk of doing much mischief; that they are re- 
commending a method of treatment very far from being calculated 
to lessen the ratio of mortality ; that of the cases which appear 
to have been greatly benefited, or cured by the use of quinia given 
in the heroic way mentioned, not a few have got well in spite of 
the treatment; that others are seriously injured by it, or receive 
the seed of much subsequent mischief; and that, of those who suc- 
cumb under the plan in question, many might have had a better 
chance of recovery if treated in a different way. 

The supposition must appear the more natural, when we reflect 
that more than enough may be gathered from experiments insti- 
tuted in England, France, Italy, and this country, as well as from 
clinical observations made by most reliable authorities in all parts 
of the world, to demonstrate, beyond the possibility of doubt, that the 
sulphate of quinia possesses toxical properties of no inconsiderable 
power, and sufficiently glaring to prevent all prudent physicians from 
trifling with it, and from using it, without absolute necessity, in the 
enormous doses resorted to by a few French and Italian practi- 
tioners, but more particularly in certain parts of this country ; often 



AUTUMNAL FEVEES. 479 

without the most remote regard to the idiosyncrasy of the patient, 
to the condition of the stomach or bowels, and to other circum- 
stances of like importance. Let the reader turn to the results of 
experiments on dogs and other animals, and he will find that, when 
given in large doses, quinia has occasionally produced stupor, dilated 
pupils, coma, convulsions, and death ; and that dissection in such 
cases has revealed congestion of the brain and its membranes, and 
a fluid state of the blood. What is more to our present purpose, 
the experiments of Magendie, Melier, and others exhibited, besides 
the phenomena mentioned, signs of congestion of the lungs during 
life, and complete hepatization of these organs after death. 1 Turn- 
ing to the human species, we find that much mischief has sometimes 
resulted from the same remedy. Cases could here be referred to, 
in which an active quinia treatment, pursued with the view to cure 
what was supposed to be obscure remittent fever, gave rise to sun- 
dry and very distressing nervous symptoms, which it required much 
time to eradicate. I have now in my mind a case of that kind of 
fever, treated in strict accordance with the rules of the method in 
question, by one of its most zealous and experienced advocates, and 
with which I became conversant in the South ; in which the patient, 
although she recovered from the disease, had a tedious conva- 
lescence, and remained for years a martyr to the effects of extra 
quiniaism. The remedy, when administered in large, sometimes in 
moderate, doses, has given rise, besides tinnitus aurium — its usual 
attendant — to agitation, headache, vertigo, subsultus tendinum, deli- 
rium, coma, hsematuria, frequent micturition, dysuria, amaurosis, 
deafness, gastralgia, gastro-enteritic inflammation, diarrhoea, epileptic 
symptoms, extreme prostration, paralysis, loss of speech, uterine 
hemorrhage, numbness and coldness of the surface, echymosis, pe- 
techias, &c. 

In all this, I am fully borne out by the results of the experi- 
ments of Briquet, 2 already referred to, of Bennet, 3 Melier, 4 Deside- 
rio, 5 Geromini, 5 Baldwin, 7 and others. Thus, the experiments of 
Desiderio show that quinia, when given in large doses, produces 
drowsiness, a difficulty of keeping the erect posture, a tendency to 

1 Melier, op. cit. 726, 729. 2 Op. ait. xxvii. 549. 

3 Edinb. Monthly J. Jan. 1852; Am. J. Oct. 1852, p. 491. 

4 Mem. de l'Acad. de Med. x. 722. 

5 Comptes rendus de l'Acad. des Sciences, xx. 370. 6 Op. cit. 

7 Am. J. (N. S.) xiii. 292. See also Fereira, Mat. Med. ii. ; Lancet, xxxix. 



480 PNEUMONIA AND 

immobility, dimness of vision, and a dropping of the eyelids. 
Acetate of morphia and alcohol, when given in suitable doses (the 
size of these differing according to the kind of animals experimented 
upon), produce effects analogous to those resulting from quinia, and 
when administered in cases in which the latter has been freely 
given, add their effects to those occasioned by the other. On the 
other hand, distilled laurel-water produces effects of a contrary kind, 
and may, to a certain extent, be considered as an antidote to qui- 
nia. Bleeding is still more efficacious in that respect. Powdered 
digitalis appeared to produce analogous effects. The experiments 
of Briquet himself, upon which stress has been laid by the advocates 
of the heroic quinia practice, prove that, when thrown into the 
bloodvessels, the remedy produces cerebral excitement, and gene- 
rally convulsions. When it penetrates the brain in an indirect 
manner, there is, first, a certain amount of general agitation; then 
follow debility, headache, vertigo, tinnitus aurium, and paralysis of 
the acoustic nerves, intolerance of vision, burning sensation in the 
orbits, weakness of sight, dilatation of the pupils, and blindness, 
numbness of the skin of the face, subsultus tendinum, trembling of 
the limbs, an appearance of intoxication; then a general collapse 
and loss of muscular power, diminution or cessation of pain in cases 
of neuralgia. Autopsy reveals injection of the large vessels of 
the pia mater, slight sandy injection of the substance of the brain, 
and sometimes meningitis. 

The same experiments establish the fact that quinia produces an 
hypersemic or engorged state of the lungs. In small doses it ex- 
cites the lining membrane and secretory organs of the mouth, pro- 
duces salivation, and increases the appetite and digestive powers. 
When given in large quantities, and persevered in for some time, 
it sometimes produces inflammation of the mucous membranes; 
and gives rise to vomiting, colic, diarrhoea, and all the phenomena 
of gastritis and enteritis in a mild degree. The urinary organs suffer 
irritation, as manifested by pain, frequent desire to make water, 
haematuria, dysuria, and even retention of urine. In women, the 
free use of the article not unfrequently gives rise to uterine hemor- 
rhage. In men, small doses excite the sexual organs, while large 
and frequently repeated doses produce reverse effects. The skin 
is benumbed and cooled, and spotted over with ecchymoses and 
petechias. While doing all this — while producing these various 
morbid changes in the tissues and organs, quinia affects the compo- 



AUTUMNAL FEVERS. 481 

sition of the blood, which, according to many, 1 it notably defibrinates, 
and renders fluid, dark, and incoagulable; or, as would appear to 
result from the numerous experiments and observations of Briquet, 2 
it renders, on the contrary, richer in fibrin; and it would not 
be difficult to point out instances in which, when pushed to what 
certain physicians in our country would regard as safe and even 
moderate doses, it has caused death, 3 not only in animals experi- 
mented upon, but in the human species. 

"With these facts before us, it cannot be deemed improper to 
suggest the necessity of abstaining from administering the remedy 
in larger closes than are strictly necessary to insure its specific 
effect — which effect, in fevers, especially, is due not so much to the 
sedative as to the purely antiperiodic property it possesses. That 
this property, which the advocates of sedation have often con- 
founded in theory with the latter is real, will not be denied by 
those who have seen quinia stop intermittent fever without pro- 
ducing any apparent effect on the system, save a little buzzing of 
the ears. In the next place, it is not improper to suggest the pro- 
priety, as a general rule, of desisting, except in cases of extreme 
emergency, from the use of it during the continuance of high febrile 
excitement, and especially during the existence of well-marked local 
inflammation, and of reserving it for the period when by other 
means an abatement or removal of these have been obtained ; or 
for those instances in which the disease assumes a congestive or 
pernicious character, and must be put a stop to at all hazard. Let 
it not be forgotten that some of the most decided believers in the 
sedative property of quinia, who are friendly to its use in large 
doses in fevers — intermittent and remittent — and have tried it on a 
large scale, are decidedly opposed to its employment in those dis- 
eases whenever the surfaces with which it comes in contact — the 
mucous membranes of the stomach and bowels — are in a state of 

1 Magendie, Lecons sur les Phenomenes Physiques de la Vie ; Metier, Mem. de 
l'Acad. de Med. x. 725, &c. ; Giacomini, Annali Universal de Medicina, March, 1841 ; 
Baldwin, Am. J. xiii. (N. S.) 299; Guersant, Diet, de Med. xxvi. 567; Bulletin de 
l'Acad. de Med. viii.^905; Bonora and Arvedi, Ann. Univ. de Medicina, March, 1843, 
quoted by Melier; Monneret, Mem. sur le S. de Q. a haute dose, June 27, 1843; Le- 
groux, op. tit. 

2 Traite Therapeutique, &c. 82, &c. 

3 Depuisaye, Examinateur Med. 15th Feb. 1843, quoted by Melier, 733; Briquet, 
Journal de Med. de M. Beau, quote i by Melier ; Pi6dagnel, communicated to Melier, 
Baldwin, op. tit. 293, 299: Guersant, op. tit. 5G8. 

31 



482 PNEUMONIA AND 

inflammation. Among these may be mentioned Briquet himself, 
who not only found, in his experiments, that this substance occa- 
sionally produces an inflammatory irritation of those tissues, but 
noticed that it invariably occasions injurious effects whenever the 
above-mentioned parts are already inflamed. Hence, he advises the 
discontinuance or omission of the quinia in all diseases in which 
those membranes are so affected. And as this condition, or at least 
a morbid state of irritation approximating to it, obtains very com- 
monly at some period of remittent, and is not unfrequently encoun- 
tered during the exacerbation of intermittent fevers, we may under- 
stand that, in the opinion of the great apostle of sedation himself, 
the use of quinia is very frequently contra-indicated in those dis- 
eases, and certainly should not be resorted to indiscriminately, and 
without due regard to the condition of gastro-intestinal surfaces. 1 

Be this, however, as it may, as regards autumnal fevers gene- 
rally; considering — what every one knows — that, more than any 
other remedy, quinia finds a useful application in such fevers ; 
admitting, for the sake of argument, that it really exercises a seda- 
tive action in them; that it may be both safely and advantage- 
ously administered in large doses during the exacerbation; and 
that the inflammation which accompanies malarial diseases is so 
modified by the poison that the system is enabled to tolerate, with 
comparative impunity, large doses of the medicine, nothing of the 
kind can be affirmed in regard to ordinary inflammations — that of 
the lungs among them ; if not in a special manner. In these, qui- 
nia, in the hands of skilful observers, has not usually been found to 
exercise the pure sedative effect in question ; and so far from gene- 
rally proving beneficial, it has often, when administered during the 
force of the febrile excitement, exasperated the disease. Such is the 
case when quinia is given in the usual quantities; and surely, we 
have no reason to believe that the system, in such cases, is under 
the influence of a modifying agency capable of placing it in a con- 
dition to tolerate the medicine in the large and indeed immense 
doses we occasionally hear of. 

It would be the height of impropriety, therefore, to argue, from 
the real or supposed benefit of quinia in autumnal fevers, that the 
remedy will be equally useful in pneumonia; and to conclude, from 
this similarity of effects, that the two diseases are identical in nature 

1 Traits Therapeutique, &c. 265. 



AUTUMNAL FEVERS. 483 

and causation, and that pneumonia is only a particular form of 
periodic fever. The impropriety of the conclusion will appear the 
more evident; because, while quinia is of immense benefit in 
periodic fevers, and may, as some aver, be used safely in them 
during the existence of fever, or even inflammation, it is found 
that it not only acts injuriously in pneumonia, but, when given in 
large doses, has at times exhibited a tendency to produce the 
evil we wish to remove. On this subject, the facts mentioned 
by Melier (733, 734), and Baldwin (xiii. 299), can leave no doubt ; 
while the reality of the tendency might, in the absence of those 
facts, have been foreseen from the results obtained on dogs and 
other animals, and to which, reference has already been made. 
Nor is it less certain that the use of quinia in pnenmonia has been 
discarded or its benefit doubted, even by some of the strongest 
advocates of its sedative action, and of its employment in the 
exacerbation of antumnal fever. Dr. Boling says: "As an anti- 
phlogistic remedy in elevated and healthy localities (i e. in which 
the disease is not complicated with or modified by malarial fever), 
it will probably never supersede the lancet, &c, though it may, in 
many cases, be brought to their aid." 1 " It may be administered," 
says Dr. Upshur, "during the intensity of the febrile paroxysm, but 
not if the fever is the result of pnenmonia and arachnitis ; and the 
physician who should give quinia in these diseases, to reduce the 
pulse, because he had seen it produce such an effect in remittent 
fever or rheumatism, would commit a great blunder." 2 Not differ- 
ent is the opinion of Dr. Lewis, of Mobile, 3 and other physicians of 
the South, who use quinia only in cases requiring tonics and stimu- 
lants, and shun it in truly inflammatory pneumonia. 

A still later, and very intelligent Southern medical writer — a 
strong advocate of its use in the active stage of remittent, inter- 
mittent, and continued fevers — Dr. McCaw, of Kichmond, Va., re- 
marks : " Quinia does not apply itself to the cure of inflammation 
of a local character. It is not, in my opinion, an antiphlogistic at 
all." "I know that some of the quininists do say that it is of great 
use as a sedative, even in this class of diseases. I do not think so 
myself. I have not found it so, certainly. I have given it many 
times during the progress of pneumonia and pleurisy ; complicated 

1 American J. viii. 110. 2 Stethoscope, ii. 437. 

3 N. 0. J. iv. 174; ii. 629. 



484: PNEUMONIA AND 

with intermittent and remittent fever, I have always seen it cure 
the complication, but never the inflammation. In truth, the short 
stimulating stage of the remedy would possibly acid to the inflam- 
mation, but that its special influence over the accompanying fever, 
stopping the daily paroxysms of congestion which must be so per- 
nicious to the favourable termination of the disease, amply repays 
you for this slight mischief." 1 " Notwithstanding the opinion of 
contra-stimulists," says a high authority, " it is admitted by unpre- 
possessed physicians, that Peruvian bark (and its salts) aggravates 
pare acute inflammation, and it is hurtful in almost every paren- 
chymatous and membranous inflammation. It aggravates pneu- 
monia and gastro-enteritis with regular fever. It is not less injuri- 
ous in inflammatory diseases farther removed from the centre of 
the circulation," 2 &c. 

Briquet himself, who as much as any one has insisted upon, and 
endeavoured to prove by experiment on animals, and the results of 
clinical observation, the sedative action of the quinia, and the neces- 
sity of using it in all febrile diseases, to moderate the action of the 
heart and arteries, acknowledges, in his very recent volume on the 
therapeutic employment of the remedy: 1st, that the coexistence 
of a large proportion of fibrin in the blood, or that of a severe 
inflammation of the membranes, and especially of the parenchyma, 
exercise on the heart an influence which the sedative property in 
question, administered in safe doses, cannot neutralize ; 2d, that the 
administration of quinia, given in doses sufficiently large to insure 
its sedative effects on the circulation, produces in the economy a 
sufficiently serious perturbation to induce us to avoid the risk of 
it, in cases in which, from the severity of the disease, it becomes 
urgent to put a stop to it. 3 

The only instances of pneumonia in which quinia has been found 
undeniably and decidedly useful for the purposes contended for, are 
those in which the periodic element is marked by well-defined remis- 
sions, or complete intermissions, and the malarial complication is 
clearly exhibited. It matters not whether these intervals be of long- 
duration, and exhibit the quotidian or tertian types, or whether 
the exacerbation or paroxysm return after a few hours, or even a 
single hour of repose — a phenomenon which we know to occur in 

1 Stethoscope, ii. 670, 671. 2 Guersant, Diet, de Med. xxvi. 584. 

3 Op. cit. 116. 



AUTUMNAL FEVERS. 485 

other forms of diseases. 1 In these, and in every other case in 
which this periodic element is manifest, quinia should, undoubtedly, 
be resorted to, more especially when the disease displays a per- 
nicious or malignant tendency — a circumstance which renders the 
recurrence of a paroxysm of the utmost danger. These cases, in 
which the inflammation is in all probability modified by the 
malarial taint, in such a way as to tolerate the use of remedies, 
which, under other circumstances, could not be borne with impu- 
nity, resist every other mode of treatment. They cannot be cured 
by antiphlogistics alone ; for although by these the inflammatory 
affection of the lungs may, if uncombined, be removed, the malarial 
fever or taint is not to be so destroyed ; and the recurrence of every 
paroxysm or exacerbation, has the effect of aggravating the local 
disease; which cannot, therefore, be eradicated, unless a stop be put, 
by anti-periodic remedies, to the complicating complaint. With 
the cessation of the latter, the pneumonic inflammation, if it has ' 
not reached beyond the first stage, generally disappears also. In 
other cases, it abates considerably, as indicated by an improvement 
in the general symptoms and physical signs. In others, again, it 
continues. When this occurs, it must be treated by the usual 
means. But these cases, which, as already said, are generally, if 
not universally, the product of a malarial influence superadded to 
the ordinary cause of the disease, afford us examples, not of simple 
pneumonia, but of positive complications of this disease with 
periodic fever, or of its modification through the agency of the 
febrile poison. As a natural consequence, they are rarely, if ever, 
encountered in our large cities, or in very many places where, 
though pneumonia prevails extensively, the malarial poison is not 
evolved, or exercises its baneful influence with little force, and 
during a short period of time only. On the other hand, they are 
of frequent occurrence in miasmatic regions generally, and nowhere 
more so than in our Southern and Southwestern States, where the 
quinia has consequently been used successfully. It cannot be 
surprising, therefore, that Dr. Farrar should remark, in his medical 
topography of Jackson (Miss.): "In this climate, a stage will 
usually be seen in pneumonia, when quinia may be used with 
freedom and efficiency, which for some years past has been my 
experience." 2 Others have written or spoken to the same effect. 

1 Melier, Mem. de l'Acad. de Mdd. x. 551. 

2 Fenner's Southern Reports, i. 357. 



486 PNEUMONIA AND 

But in such cases, I repeat, we are not to recognize pure, but com- 
plicated and modified pneumonias. 

In them, the disease receives, by virtue of its association with 
malarial fever, the periodic type by which the latter is character- 
ized, and is benefited by quinia, not in consequence of the sedative 
or contra-stimulant action of this remedy on the local disease and 
the system at large, but of the anti-periodic power it possesses, and 
by which it is enabled to arrest the progress of the malarial, or 
periodic and complicating fever. The older physicians used bark 
freely in such cases, a point upon which the reader may refresh his 
memory by referring to the writings of Torti, Morton, Lauter, Ali- 
bert, Mongellaz, Gouraud, as well as to an essay on intermittent 
irritations, published in form of a review in an early volume of the 
North American Medical and Surgical Journal, by the author of the 
present volume. " There is no one among us," says Sarcone, "who 
is not in a condition to present numerous observations respecting 
the happy results obtained by cinchona in affections of the lungs ? 
combined with periodic fever. Messrs. Serao, Yentapane, Rubertis, 
Cinque, Yisoni, and others, have effected memorable cures with 
bark in diseases of the same nature, not only this year (1764), but 
also in the preceding ones. I myself, though confessedly young 
in the profession, and of little importance in comparison with men 
of eminent talents, such as those I have had the honour to name, 
am able to adduce numerous examples of the useful employment 
of that remedy in the diseases in question." 1 The use of quinia in 
the same disease is universally resorted to. I have myself em- 
ployed it largely by the mouth or rectum, and have seen it em- 
ployed by others both at home, in the south of this country, and in 
Italy, where instances of the kind are not uncommon. Of course, it 
is a matter of indifference whether the inflammation be in the lungs 
or elsewhere. Whenever it assumes a decidedly remittent or an 
intermittent type, and is blended with a malarial fever, or modified 
by a malarial taint, and more particularly whenever signs of malig- 
nancy or congestion manifest themselves, quinia should be resorted 
to, and that promptly. We must, as is well remarked by Dr. Mer- 
rill, take advantage of the first remission, otherwise we may expect 
the second exacerbation to become more violent than the first ; an 
effect due, in part, to the fact that every violent paroxysm of fever — 

1 Maladies de Naples, i. 212. 



AUTUMNAL FEVERS. 487 

more particularly when preceded by a chill — tends to aggravate 
the local inflammation or congestion, and prostrate the nervous 
power. Be this, however, as it may, cases such as have just been 
alluded to, are in a great measure exceptional, and their occurrence, 
as well as the treatment they call for, proves nothing, so far as re- 
gards ordinary and uncomplicated pneumonia, in which the qninia 
practice would stand but little chance of proving useful. Now this 
practice being found inapplicable to the greater number of cases of 
pneumonic and other inflammations, of doubtful necessity in others, 
and only decidedly important in a comparatively few instances of the 
disease — and those, too, in which the periodic type evidently arises 
from the complication or modification mentioned — the argument 
founded on the success or superiority of the mode of treatment in 
question in pneumonia cannot be sustained; for that usefulness or 
superiority, as regards the disease generally, is very far from being, 
as yet, proved. The first postulate must, therefore, be abandoned. 
As to the second — that the success of quinia in pneumonia must 
be viewed as a sure proof that this disease is identical with, and 
constitutes only a particular form of periodic or autumnal fever, in 
the treatment of which that remedy is, if not a specific, at least a 
most efficacious remedy; it need only be remarked that, even were 
we disposed to recognize the validity of the claims set up in favour 
of quinia in all instances of pneumonia, it would be illogical to 
deduce from that superiority a proof of the identity in question. 
As every one knows, quinia is daily used advantageous^ in dis- 
eases which owe their origin to causes very different from the legiti- 
mate poison of autumnal fevers, and which, nevertheless, it is not 
probable any one would be disposed to regard as constituting really 
and substantially anything more than particular forms of those 
fevers. In articular rheumatism, arising without malarial taint, 
and having nothing in the world in common with autumnal fevers, 
it has been and is employed by Briquet and others, with, as it is 
said, great utility. No one but Dr. Macculloch will be inclined to 
maintain the intimate and constant dependence of neuralgia upon 
intermittent fever, and to regard it as being produced exclusively by 
malaria. That it is often, as remarked by Dr. Drake (863), the con- 
sequence of autumnal fevers, especially when it assumes the periodic 
type, no one will deny. But it is also found to be the consequence 
of other complaints in no way allied to such fevers ; — cases occur- 
ring and assuming the intermittent character under circumstances 



488 PNEUMONIA AND 

which forbid the idea of any malarial agency. Nevertheless, quinia 
is often beneficially employed in the various forms of that painful 
disease. 

Whatever be the cause of periodicity in a disease, or rather what- 
ever be the nature and cause of a disease, which presents a well- 
marked remittent or intermittent character, quinia will be found 
a useful remedy in its treatment. It is useful also in certain 
nervous disorders in which the periodic element does not manifest 
itself, and which have no more to do with periodic fever than with 
smallpox or syphilis ; and if we conclude that pneumonia, generally, 
is really and substantially nothing more than a peculiar form of 
remittent and intermittent fever, and should take its appropriate 
place (in company with pleurisy, &c.) under the plain designation — 
periodic/ever, on the ground that certain cases of it are, under par- 
ticular circumstances, and at a particular period of their course, 
greatly benefited or arrested by quinia; if with Dr. Forry, and 
others, we admit that the subjection of these diseases to the same 
remedies which are found to arrest the course of the one, also 
arrests the course of the other, " implies a close alliance, if not a 
common origin;" 1 we shall be led to conclude, also, that all the 
other disorders in which it may be useful — wheresoever the locality, 
and at whatsoever season they may show themselves — are of ma- 
larial origin ; and must, in like manner, take their appropriate 
place under the same plain designation. Such a mode of reasoning 
would lead us, if we wish to be consistent, to pathological deduc- 
tions, at which our good sense must revolt, and which would ill 
accord with the principles of the inductive philosophy so dear to 
some of our opponents. No one will deny that mercury is the 
remedy for syphilis; for although, in the days of our infatuation for 
the Broussaian doctrine, many practitioners denied the necessity or 
propriety of that remedy, and attributed to it a thousand evils, 
experience has shown, and no less an authority than Ricord main- 
tains, that it is superior to every other means, especially in the first 
stage of the disease, and that in many cases it cannot be superseded 
by any other. But mercury is found very useful, and even indis- 
pensable in various complaints: in hepatic and other glandular 
derangements; in inflammation of the serous membranes of the 
abdomen, chest, and head ; in sundry diseases of the eye ; iritis, for 

1 Op. tit. 185, 186. 



AUTUMNAL FEVERS. 489 

example. It is useful also in various other inflammations and en- 
gorgements, and even in some forms of periodic and malignant 
fevers. Surely, we shall look in vain for a pathologist disposed to 
conclude that the benefit derived in these latter diseases from mer- 
cury indicates their identity with, or dependence on s} T philis, of 
which mercury must be viewed as the specific. If such an admis- 
sion cannot be entertained — if we acknowledge that the advantages 
derived from mercury, in the diseases mentioned, in no vrstj justify 
a belief in the identity of these with syphilis, it is difficult to per- 
ceive the propriety of viewing pneumonia as nothing more than a 
particular form of periodic fever, on the plea that quinia may prove 
useful when resorted to at the period of remission. The second 
limb of the argument, founded on treatment, must, therefore, like 
the first, be set aside. 

The hypothesis of the identity of pneumonia with autumnal fever 
not supported by facts and solid arguments. — But it is scarcely 
necessary to pursue the subject any farther. If what has been 
said is correct, neither the symptoms observed during life; the 
anatomical characters revealed after death in pneumonia and 
autumnal fevers; the treatment found useful; the mode of pro- 
gression of those diseases; the localities in which they prevail; 
the external agencies by which they are influenced, nor any other 
point to which I have adverted, afford any support to the belief 
of their being pathologically identical, or of their arising from 
the same cause. The theory under examination must, therefore, 
fall to the ground, and those who uphold it stand chargeable with 
having ventured on a hasty and illogical conclusion. Indeed, they 
have built up, not a theory, but simply an hypothesis, resting on 
mere assumptions and conjectures. I say assumptions; for we look 
in vain in the writings of those who, discarding generally received 
opinions, have revived the hypothesis in question, for any facts or 
arguments calculated to sustain the position therein assumed. Thus, 
we are told by Dr. Merrill, in a passage already quoted, that, ac- 
according to his observations, " the pneumonias which prevail in 
this country generally — sometimes sporadically, and frequently as 
an epidemic — are really and substantially nothing more than a 
peculiar form of remittent and intermittent fever." In another 
page the writer says : " Let us talk as learnedly, and refine, dis- 
criminate, and vary our nomenclature as we may, to suit the fash- 



490 PNEUMONIA AND 

ion of the times ; when we come to deal with plain facts, as they are 
presented to us in practice, this whole class of diseases, to which I 
have here alluded (pleurisy, pneumonia, &c), will be found to take 
its appropriate place under the plain designation, periodic fever" 
This fever, it is maintained, is a general disease, affecting the whole 
system; but this general disease probably never exists without 
evincing a strong determination of diseased action to some par- 
ticular organs. If the brain be particularly implicated, the disease 
assumes the shape of phrenitis ; if the stomach, we have gastritis ; if 
the liver, hepatitis ; if the lungs, pneumonia, &c. All this, and 
much more of the same tenor, is affirmed as matter of fact. The 
decision, as it would seem, is without appeal; and all who refuse to 
acquiesce in it, run great risk of being stigmatized as having re- 
mained behind the times. But no pains is taken — no attempt 
made — to substantiate the particular opinions thus thrown out. 
Nothing is offered in their support; nothing calculated to show that 
the writer, who has hazarded them, is right, and all who have enter- 
tained, or continue to entertain different sentiments, are wrong. 
So far from it, we discover nothing but the bare statement ; nothing 
having the most distant appearance of proof; nothing, certainly, so 
far at least as I have been able to discover, which may be viewed 
in the light of solid or plausible argument, based on correct and 
accurately observed facts, and calculated to satisfy sound patho- 
logists and etiologists. For it cannot be supposed, after all that 
precedes, and in the present state of professional opinion relative to 
the reality and frequency of complications, arising from the co- 
agency of two or more distinct and independent causes, and of the 
successive evolution of separate diseases, that we shall admit, as a 
sufficient proof of the identity contended for, the circumstance that 
in some cases the symptoms of pneumonia are combined with a 
greater or less number of those of periodic or malignant fever, and 
vice versa; that pneumonia coexists with, or succeeds to, these 
fevers ; and that when the affection of the lungs, owing to such a 
complication, or to some other morbid agency, assumes the remit- 
tent or intermittent type, quinia will be found an appropriate 
remedy. 

Let it not be said, in proof of the unity of all febrile diseases — 
the thoracic and other inflammations included — and of the identity 
of their efficient cause, that writers draw a line of distinction be- 
tween two cases of disease, in which no one can detect the slightest 



AUTUMNAL FEVEKS. 491 

difference while they are in progress. Let us not be told, by our 
opponents, that "it may be a good employment for students in medi- 
cine to learn the distinctive character of each variety so invented 
and described, but when we approach the bedside of the sick, we 
find it difficult enough, and useless enough, to designate the precise 
nosological position to which each particular case belongs." As- 
suredly, the thrust here made at medical writers cannot have refer- 
ence to the distinction they may point out between pneumonia and 
periodic fever ; for it is scarcely possible to suppose that any one 
who has attended one month to clinical studies could confound them 
together so far as regards their phenomenal and anatomical characters. 
Allusion must be made to the line of distinction drawn between the 
various forms of fevers themselves. Now, I take upon myself to 
answer, that though some writers, as Copland, may have been 
guilty of too much refinement in their subdivisions of fevers, the 
fault is not universal ; that in writings of deserved reputation, no 
greater number of varieties of that class of disease is admitted than 
can be proved to have an independent existence ; and that, so far 
from there being any reason to conclude that there is not the 
slightest difference discoverable during the progress of cases be- 
tween which writers draw the line in question, it is ten, nay, a 
hundred to one, that, when an identity between such cases is affirmed 
to exist, by the ordinary run of physicians, in opposition to the 
opinion of professional writers of admitted experience, and who, 
while having at their command the means of investigating the sub- 
ject on a sufficiently ample scale, and in all its branches, are well 
trained in the art of conducting such an investigation, the cause of 
the opposition is to be found, not in the fact that the latter are 
really at fault, but in the inattention, carelessness, theoretical pre- 
possessions or limited knowledge of the individual who undertakes 
to pronounce an opinion on the nature and proper nosological posi- 
tion of the cases placed before him. 

The science of diagnosis is far from being one of the easiest to 
master. Indeed, the more we proceed in the study of it — the more 
we investigate, analyze, and compare the distinctive features of 
diseases, their pathognomonic phenomena, their points of analogy 
and dissimilarity — the more satisfied must we become, that it is not 
every physician who can safely be entrusted with the task of dis- 
criminating between the various forms of febrile complaints, pro- 
perly so called ; especially if these present, as they sometimes do, 



492 PNEUMONIA AND 

phenomena of a somewhat approximative character, or blend with 
each other in the way already mentioned. Errors are often com- 
mitted, especially at the outbreak of an epidemic, even by those 
who have made a particular study of this branch of medical know- . 
ledge, and enjoyed the advantages afforded by an extensive field of 
observation in public and private practice. They must, necessarily, 
be more frequently so by the less informed, expert, experienced, or 
careful members of the profession, or by those who do not enjoy 
the opportunity, or whose time is too much engrossed to prosecute 
the study of pathological anatomy and other branches of medical 
knowledge, without which it is in vain to pretend to accuracy in 
diagnosis. Individuals of this kind necessarily abound in every 
community, though nowhere perhaps more than in this country. 
Many, hence, may be very apt to see identity, where more experi- 
enced, accurate, and trustworthy diagnosticians and pathologists 
will detect diversity. The physicians of Charleston find no diffi- 
culty in distinguishing the yellow or stranger's fever from the 
ordinary endemic remittent of the adjacent country, which by some 
has been, without due attention to distinctive phenomena and other 
important circumstances, confounded with the former. The same 
may be said of other diagnosticians and experienced observers in 
various parts of this country, in the West Indies, on the coasts of 
South America and Africa, and in Europe, who draw the line of 
demarcation between those fevers with undeniable precision. 

The best French and English pathologists, as well as many accu- 
rate and sound observers in this country, have learned to draw a 
proper distinction between typhus and typhoid fevers, and so on 
of other febrile complaints ; and they would probably demur to the 
opinion of those who venture to maintain that typhus and typhoid 
fevers are identical with bilious, remittent, and yellow fevers. In 
fact, the farther knowledge has advanced — the more closely the 
phenomena of the diseases mentioned have been analyzed and 
compared — the more their mode of progression has been scruti- 
nized and their anatomical characters minutely and accurately 
studied, the greater has been the tendency among medical men to 
draw a precise line of distinction between their several forms. So 
great, indeed, has been the change in that respect — such the in- 
crease in the number of its advocates in quarters where minute 
and correct observations are alone to be looked for, that we cannot 
err greatly, when we express the opinion that the day is not far 



AUTUMXAL FEVERS. 493 

distant when physicians generally, regardless of the clamour of a 
few opponents, will feel no more disposed to jumble up together 
the different varieties of fevers, as is still but too often done by a 
certain class of physicians, than they do now to regard, as did our 
ancestors, smallpox, measles, and scarlet fever as one and the same 
disease, really and substantially. 

That difficulty is experienced in making out the diagnosis of 
fevers, especially in the commencement of an attack, no doubt can 
exist. The difficulty is often felt, even by experienced physicians, 
in the case of diseases, the nature and causes of which differ essen- 
tially, and which approximate only in being attended by symptoms 
of constitutional excitement. On this subject I need hardly insist. 
It is, or certainly ought to be, admitted by all who have the least 
smattering of practical medicine. If this be true in reference to 
such diseases, the embarrassment may well be admitted to occur 
much more frequently when the complaints to be diagnosed are of 
the same family, though of different species ; for all know that in 
such diseases the full development of the phenomena which serve to 
characterize the case, is usually preceded by febrile symptoms very 
similar in all ; and well calculated, on that account, to create diffi- 
culty in respect to the diagnosis. If we take, for example, the 
incubative symptoms in continued fever, we shall find that the 
description of them may apply to many of the acute blood or 
zymotic diseases. 

The following catalogue of symptoms I borrow, like Dr. Simons, 
from Dr. Watson's matchless book on the practice of medicine. 
'• The expression of the patient's countenance alters ; he becomes 
pale, languid, and abstracted ; those about him observe that he is 
looking very ill. He is feeble, and easily tired ; reluctant to make 
any exertion of mind or body ; listless, and often apprehensive of 
some impending evil ; he loses his appetite ; his tongue becomes 
white, and inclined to tremble; the bowels are irregular, often con- 
fined, sometimes affected with diarrhoea; his senses lose their 
natural delicacy. He has uneasiness or wandering pains in various 
parts of the body, and occasionally there is some giddiness ; drow- 
siness, perhaps, during the day, and unsound, unrefreshing sleep at 
night. In a word, the patient droops. The regular onset of the 
fever is very frequently, indeed, marked by a shivering fit ; another 
common phenomenon at the period of the invasion is severe head- 
ache. But you will also perceive, even when there have been no 



494 PNEUMONIA AND 

premonitory circumstances, that symptoms arise, even thus early, 
which belong to the nervous system, and denote some disturbance 
and alteration in the functions of sensation, thought, and voluntary 
motion. They are comprised under the general phrase, ' febrile 
oppression,' and they are different from what we notice when 
pyrexia or feverishness supervenes upon inflammation. The mus- 
cular power is sensibly enfeebled. Sometimes the patient will 
struggle against this, but in a few hours, or in a day or two at far- 
thest, he takes to his bed." 

To these symptoms, which, as Dr. Simons remarks, constitute 
equally a picture of most of the diseases of the class, there succeed 
a stage of reaction in which fever runs more or less high. The 
skin is hot and dry, sometimes moist ; the pulse is excited, thirst is 
developed, and so on of other symptoms familiar to all physicians ; 
and it is only after these have continued more or less time that the 
characteristic phenomena manifest themselves, and the true nature 
of the case is satisfactorily made out. Exceptional cases, doubtless, 
are found, in which from peculiar signs, aided by various concomi- 
tant circumstances, the diagnosis may be established earlier. But 
in general it is not so ; and every prudent physician finds it better 
to avoid precipitancy in the expression of his opinion. With Dr. 
Nbtt, therefore, we must all concur, when he remarks : " If a phy- 
sician were called in the forming stage of a number of cases of the 
plague, smallpox, yellow fever, some forms of typhus, and other 
diseases arising from morbid poisons, as well as certain vegetable 
poisons, he would be much at a loss how to distinguish them for 
two or three days ; and in some of those in which the characteristic 
signs are never developed, as smallpox without eruption, &c, a 
diagnosis never could be made. It should not be wondered at, 
then, that difficulty of diagnosis should sometimes occur between 
bilious and yellow fever, which belong to the same family, the same 
season, and (often) the same locality." 1 Another cause of difficulty 
in the diagnosis depends on the occurrence of the complications 
already adverted to ; for it is a circumstance well understood by 
observant and experienced pathologists, and which has not escaped 
the notice of some of our distinguished Southern physicians, that 
when two or more epidemic or atmospheric diseases prevail to- 
gether, they become blended. Under circumstances of the kind, 

1 N. 0. J. iv. 584. 



AUTUMNAL FEVERS. 495 

yellow fever, especially if it prevails in a mild form, and does not, 
by the wide diffusion and great energy of the poison giving rise to 
it, take exclusive possession of the field, becomes more ■ or less 
blended with remittents and intermittents of all grades, and forms 
with these compounds, which may sometimes embarrass the most 
correct diagnostician, and are sure to puzzle and confuse those less 
expert in matters of the sort, and to lead them to doubt the pro- 
priety of establishing a line of demarcation between those fevers. 

The physician who would be astonished at the appearance of 
black vomit, in a case of what he fancies to be ordinary fever, and 
who would always wait till the occurrence of that formidable symp- 
tom before establishing his diagnosis and pronouncing the disease 
to be yellow fever — who could not know the latter to be such till 
the patient was in articuh mortis — should be advised (supposing the 
case to have been really of the kind mentioned — for every one 
knows that black vomit alone is not sufficient to characterize yellow 
fever) to go back to school, or to keep his eyes wider open the next 
time. If the appearance of black vomit were indispensable to enable 
the physician to establish his diagnosis, it would follow that, in a 
large proportion of cases of what there can be no doubt is yellow 
fever, the true nature of the disease could not be positively ascer- 
tained. As a general rule, it may be stated that, in cases that reco- 
ver, black vomit does not make its appearance. In this city, the 
mortality among the reported cases has averaged one in 2.12, the 
proportion varying from one in 1.2 to one in 3.86. In other places, 
the loss has occasionally been less. The number of those who 
escape that symptom must hence be everywhere larger than that 
of those who suffer from it. The amount of the former will be 
found to be even greater than here stated; for those who die do not 
all eject the fluid, and it then requires an autopsy to ascertain that 
it has been effused. And yet no difficulty is experienced, in those 
who recover, or die without throwing up the black matter, in dis- 
tinguishing the disease from other forms of febrile complaints. 
Such errors are generally the result of want of skill or want of at- 
tention on the part of the observer ; for the yellow fever, as also 
the remittent, present, together with phenomena approximating 
them to each other and to different complaints, characteristic fea- 
tures of their own, which, when duly and carefully examined and 
analyzed, prevent the one from being mistaken for the other, 
except in cases of an anomalous or complicated nature, or at the 



496 PNEUMONIA AND 

very outset of the attack — of mild cases especially — or which, at 
any rate, enable the physician to establish his diagnosis, in the ordi- 
nary forms of the disease, long before the accession of that formida- 
ble symptom. The blunders of the unskilful or careless, or the 
fancies of the unitarian must not be urged in denial of the possi- 
bility of tracing a line of distinction between the different forms of 
autumnal fevers. Let them, by way of encouragement, peruse the 
following statement made by a clever physician of Mobile : Two 
clergymen of this city, Mr. Balzan and Mr. Dorman, whose active 
benevolence has won for them much correct information in relation 
to fevers, have frequently, in my private and hospital practice, de- 
signated each variety and grade of fever with the greatest ease and 
correctness, separating the grave from the ephemeral cases of yellow 
fever, and distinguishing these again from periodic fever. In their 
diagnosis they were governed by the character of fever, pain, rest- 
lessness, colour of skin, physiognomy, paroxysms, and nature of the 
secretions. 1 

I have not unfrequently heard it affirmed by physicians of the 
South, who favour the opinion under examination, that the identity 
contended for is shown by the fact that men digging down a bluff 
will often become sickly, and have fever with periodicity. Physi- 
cians who attend them report some to be affected with hepatitis 
with complication of pneumonia, and the reverse ; others to have 
gastritis complicated with phrenitis, and the reverse ; enteritis, ne- 
phritis, &c, with their complications; remittent bilious fever, inter- 
mittent fever, yellow fever, &c. &c. Now, it is argued, all these men 
derive their sickliness from the same cause — the digging down 
of a bluff, &c. If one and the same cause can produce so many 
groups of morbid phenomena, does it not seem almost certain that 
the disease thus engendered, though designated by as many as forty 
different names, is essentially the same in all cases ? 

For my part I must, with due deference, demur to this conclu- 
sion, and express the belief that I shall be fully sustained by many 
well-informed and experienced physicians on this and the other side 
of the Atlantic, when I deny the possibility of so great a variety 
and diversity of well-marked effects resulting from the agency of 
one and the same cause ; or of the same disease assuming such a 
diversity of forms as to simulate as many as forty separate diseases, 

1 Lewis, Fever of Mobile in 1847, N. 0. J. t. 40. 



AUTUMNAL FEVERS. 497 

each entitled to a separate name, and occupying a separate place in 
our nosological arrangements. If it be found that a number of 
men, employed in cutting down a bluff, are seized with a diversity 
of what we are accustomed to regard as distinct diseases, and that 
these are all referred to the same cause ; or if we are told that the 
disease in all these cases is the same, but has assumed a diversity 
of aspects, and merely presented itself in a variety of groups of 
symptoms, which, though having in many instances little or no 
resemblance to each other, are nevertheless the offspring of one 
and the same parent, pathologists will, in all probability, be dis- 
posed to accuse the reporters with betraying a great deficiency of 
knowledge, both as regards the nature and causation of the morbid 
phenomena described ; or with an unpardonable degree of hastiness 
and carelessness in the manner of making their observations and 
drawing their conclusions; or perhaps with being under the spell 
of some preconceived notion or favourite hobby. The digging 
of no ditch or canal, the cutting down of no bluff, the levelling 
of no streets, has ever produced such diversified complaints ; and 
when we hear of physicians giving many names — no matter whe- 
ther ten or forty — to the morbid phenomena resulting from the 
agency of exhalations issuing from the upturned earth, we may 
safely set them down as erring; and as having, owing to their in- 
ability to establish a correct diagnosis, regarded in the light of dis- 
tinct diseases what other and more careful observers would have 
found to be otherwise. On the other hand, when several diseases 
are really found to occur among men thus similarly employed — a 
circumstance not unlikely to occur — it is much more natural to 
conclude that different causes have been simultaneously at work, 
and that each has produced its legitimate effects, than to attribute 
those diseases to the same agent, which, from our experience else- 
where, and under different circumstances, we have reason to think 
are incapable of giving rise to such multitudinous and diversified 
phenomena. Such diggings and cuttings produce no catarrh, no 
pleurisy, no pneumonia, &c. ; and if those diseases occur among the 
diggers and cutters, there is no reason why they should not be 
occasioned by the causes that produce them elsewhere; as well 
where fevers prevail, as where they are not observed ; as well where 
the fresh earth has been recently exposed, as where it has not been 
disturbed. From such operations, when undertaken in particular 
seasons of the year, in certain localities, and within certain degrees 
32 



498 PNEUMONIA AND 

of terrestrial altitude, diseases, sometimes of a formidable character, 
undoubtedly result. This was exemplified in New Orleans at the 
time of the opening of the Carondelet Canal, in 1794-1797; in the 
same city, during the extensive paving executed in 1817, 1824, 
1832 ; and at the opening of the Bank Canal, in 1832-1835. It was 
also exemplified in Natchez, at the period of the levelling of the 
streets, in 1816, 1825 ; at Memphis, Tenn., within the last few years; 
and, indeed, as already seen, in every place where canals, ditches, 
and other excavations have been made, and the earth extensively 
upturned. But in all such instances the disease produced has been 
fever; often of a malignant, at other times of a remittent form; 
according to the season of the year, the peculiarities of the weather, 
the nature of the soil, and other influencing circumstances, which 
it is needless to enumerate. 

I am not ignorant of the fact that, by many physicians who en- 
tertain sentiments different from those expressed in the preceding 
pages, little or no respect is paid to the opinions of professional 
writers or teachers, however eminent these may be. Few of my 
readers can have failed to hear such authorities unceremoniously 
stigmatized, by those who throw out some new or revive some 
antiquated and forgotten notion, as being a long way behind the 
times, and as having not yet renounced the Aristotelian, and fully 
adopted the Baconian philosophy. It is not uncommon, to hear it 
affirmed that the whole system of pathology and practice, etiology 
and physiology of fever and febrile affections, is founded upon pre- 
conceived notions, and not upon facts and inductions, and that it 
requires to be remodelled on more correct principles. All this, 
and much more of similar import, we are not unfrequently told in 
ephemeral publications, and even in works of higher pretensions. 
I have neither room nor inclination to examine here how far such 
assertions are warranted, and to enlarge on the degree of improve- 
ment to which medical inquirers and teachers among them have 
attained in the several departments of medical knowledge, or to 
inquire where the desired revolution in professional opinion con- 
cerning those important subjects is more likely to originate. It 
will be sufficient to remark that, in regard to the matter more par- 
ticularly before us, professional investigators — the enlightened por- 
tion of them, I mean — so far from being sadly behind the times, 
are, as every unprejudiced reader must know, far ahead of their 
predecessors ; and that nothing has been said or done by contem- 



AUTUMNAL FEVERS. 499 

porary writers, in this country or elsewhere, to disprove the cor- 
rectness of their conclusions. It is, indeed, precisely in reference 
to the very subjects specified, that the science seems to me to have 
mostly improved. An examination of professional records will 
show that, in every place where the opportunity of carrying on 
the investigation on a sufficiently enlarged scale, and with proper 
minutiae and thoroughness, has presented itself, and where men 
possessing the talents and knowledge requisite to study and extend 
the stock of information, and to lay the result of their inquiries 
effectively before the public, have set to work, the pathology, 
etiology, and therapeutics of fevers and febrile diseases (including 
parenchymatous and membranous inflammations) have been dili- 
gently and successfully studied, and our knowledge respecting 
them has been very greatly enlarged. 

The knowledge thus accumulated has been very freely laid before 
the medical public, and through means of the writings of those 
pioneers in the cause of science and of their followers, every read- 
ing physician or teacher has the opportunity, if he thinks fit to 
embrace it, of becoming fully informed as to the matter in question. 
If many, therefore, among us and elsewhere, are found to be 
truly amenable to the charge of being sadly behind the times, the 
fault necessarily lies with them and no one else. They constitute, 
at best, only a portion — I hope a minority — of our professional 
brethren. Hence, there can scarcely be any more truth or justice 
in the assertion that medical men, and professional teachers gene- 
rally, must find a place in this category of ignoramuses ; that they 
have all lagged a good way behind the times; that, therefore, their 
opinions should be discarded on the score of their being antiquated, 
and no longer on a level with the state of knowledge on the sub- 
ject, than there would be foundation for the idea that the medical 
inquirer must turn, for truly correct notions regarding the patho- 
logy, causation, or treatment of fevers, to the lucubrations of the 
above few. The assertion, I say, is not founded in justice, nor on 
solid ground ; for the opinions thus impeached are the result of a 
considerable amount of correctly observed facts, and are based on 
philosophical deductions of the strictest kind; and should, as such, be 
respected till disproved by others founded on equally well observed 
and equally numerous data. It is certain, indeed, that, so far from 
the whole system of pathology, &c. of fevers and febrile diseases 
being founded on preconceived notions, and not upon facts and 



500 PNEUMONIA AND 

inductions, a careful survey of what has been done on the subject 
in France, England, Germany, and the large cities of this country, 
will show that the views at present entertained are based upon 
nothing but facts and legitimate deductions, to the exclusion of pre- 
conceived notions ; that there never was a period when the en- 
lightened portion of medical men were less disposed to be biased 
by such notions, and when they have less allowed themselves to be 
led astray by fanciful speculation in their conclusions on pathological 
and etiological questions than at present; and that, in fact, such a 
cutting loose from the shackles of preconceived notions constitutes 
the distinctive characteristic of the present mode of investigation as 
regards the nature, the cause, the mode of progression, and the treat- 
ment of fevers and febrile diseases, and, indeed, of every other morbid 
ailment. The doctrine of Broussais, erroneous as it may appear to 
many at the present day, was based on important facts, often well 
explained, and leading to correct or plausible deductions. The at- 
tentive readers of his Phlegmasies Chroniques, of his first Examen, and 
of his Commentaries , will not gainsay me in this. The doctrine was 
faulty, not in the deficiency of the facts upon which it was based, but 
in the nature of many conclusions drawn from them. But how was 
it overthrown ? Certainly, not through the operation of a greater 
power of reasoning possessed by Broussais's antagonists, for some of 
the most successful among them are not particularly gifted on 
that score, but by facts more numerous, more carefully observed 
and analyzed, aud more accurately compared with each other. 
How have we acquired our present knowledge of the pathology of 
typhoid fever ? Open the works of Louis, Andral, Chomel, Jenner, 
Gerhard, Flint, and see whether facts are wanting. How have 
physicians attained their present views of the pathology and ana- 
tomical characters of pulmonary or cardiac diseases ? How have they 
learned to ascertain, by means of auscultation and percussion, the 
condition of internal organs ? Is it by abstract reasoning, or by 
following out and cherishing some exclusive and dominant idea, and 
forcing everything to bend to it ; some preconceived notions ; or 
is it not rather through the instrumentality of facts accumulated 
in France, England, Germany, and a small portion of this country ? 
It can scarcely be necessary to answer the question. 

Those who raise such an outcry about the necessity of facts, and 
reprove the most authoritative writers and teachers for a supposed 
adherence to preconceived notions, and a neglect of the true prin- 



AUTUMNAL FEVERS. 501 

ciples of the inductive philosophy, should first satisfy the profession, 
not only that they are less liable to error than their opponents, in 
drawing deductions from the facts they may happen to collect, but 
that these facts have been examined in a way calculated to insure 
advantageous results. They should remember that, great as the 
number of useless theories may be, it sinks into insignificance 
when compared with the amount of incomplete facts which float 
around us. To observe accurately — to seize the important and 
useful points in the case examined — to discover its true bearing 
to other cases, its exact analogy to or dissimilarity from them — 
to ascertain its dependence on, or independence of, surrounding 
influences — to point out accurately the morbid agencies which have 
produced it, and to ascend by an analysis of its symptoms and 
anatomical characters, to its pathological nature and therapeu- 
tical indications, require a degree of skill, a tact, a habit of close 
observation that are not easily acquired, as well as opportunities for 
investigation that do not fall to the lot of every one. And yet a 
writer must give proof of possessing them before he can expect to 
command the attention of the cautious inquirer, and change the 
current of professional belief. " A vast mass of facts," says a recent 
writer, "may be collected and tabulated- — the numerical method 
may be applied in every conceivable mode — and yet, so long as no 
connecting idea is discovered among them, they remain utterly 
incapable of serving for the establishment of those general prin- 
ciples which enable true science to predict with certainty what will 
not occur in any given contingency; and which, therefore, furnish 
the only satisfactory basis for the use of art as to what should or 
should not be done." A great master, Montesquieu, has said: "Un 
fait qui n'emporte pas une idee, duquel on ne peut pas s'elever 
pour voire plus loin, est un caillou qui ne vaut pas la peine d'etre 
ramasse, et qu 'il faut au contraire repousser du pied pour en de- 
barasser la route." 

What the result of the mode of proceeding adopted at this day 
by standard pathologists has been as regards the distinctive pathog- 
nomonic marks, and the separate nosological positions of the 
several forms of fevers, properly so called, has already been stated. 
Much the same may be found in reference to other febrile com- 
plaints dependent on local inflammation, as well as to other dis- 
eases ; to the symptoms and anatomical characters by which they 
are recognized, and which distinguish them from each other and 



502 PNEUMONIA AND AUTUMNAL FEVERS. 

from the pyrexiae, as well as to the causes by which they are pro- 
duced. Now if in the course of this revolutionizing movement, 
and at the present period of progressive improvement, some medical 
writers or teachers are really found to be a long way behind the 
times, it can scarcely be those who have taken an active part in the 
race of investigation, who have helped to overthrow old and 
erroneous views, and, by appealing to facts, to place matters in a 
proper light, or who have diligently and carefully studied the works 
of modern standard writers. They must be sought elsewhere. 

Here I must close the remarks I wished to offer in opposition to 
the supposed connection between pneumonia and periodic fevers. 
They have extended far beyond what was originally intended. For 
this the reader is entitled to many apologies. The greater part of 
the volume thus inflicted on him was penned somewhat in haste, 
and under the pressure of a variety of circumstances unfavourable 
to minute investigation, systematic arrangement, and correct com- 
position. With more tranquillity around me, with a larger share 
of health than I have recently enjoyed, with a freer and more con- 
stant access to publications relating to the questions at issue, and 
especially with more leisure at my command, it might have been 
presented in a shape more acceptable to those who will do me the 
honour to peruse it. But I must plead as an excuse, the. same reason 
which Voltaire assigned for having written a very long letter to 
one' of his princely correspondents — I had not time sufficient to 
write more briefly. Such as it is, with all its many imperfections 
and gross defects of commission and omission, these remarks are 
placed before the medical public in the hope that they may do some 
service, and contribute in some measure to the settlement of the 
question ; or at any rate that they may excite in others, better 
qualified for the task, a desire to point out, in an ampler, clearer, 
more logical, and more forcible manner, the groundless nature and 
dangerous tendencies of the pathological and etiological heresies to 
which I have called attention. 



THE END. 



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